Rising Above Lyme Disease

RISING
ABOVE
LYME
DISEASE
A REVOLUTIONARY, HOLISTIC APPROACH
TO MANAGING AND REVERSING
THE SYMPTOMS OF LYME DISEASE—
AND RECLAIMING YOUR LIFE
JULIA GREENSPAN, N.D.

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Text © 2019 Julia Greenspan, N.D.
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The information in this book is for educational purposes only. It is not

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Dedicated to my mother,
Janet Geil (1948–1982),
and to my children,
Sydney and Samuel—I love you!
CONTE NTS
Introduction 6
PART 1 PART 2
Demystifying Finding Relief
Tick-Borne
CHAPTER 5
Disease Stepping into
Your Power:
CHAPTER 1 Self-Advocacy
The Tick: Nature’s and Treatment 97
Dirty Needle 11
CHAPTER 6
CHAPTER 2 Setting the Stage
Diving Deeper for Treatment
into Chronic Success 115
Lyme Disease 28
CHAPTER 7
CHAPTER 3 The Foundational
More than Just Lyme Naturopathic
Disease: The Role of Treatment Plan 125
Coinfections 54
CHAPTER 8
CHAPTER 4 The Foundation
Finding the Most Is Strong—Now
Accurate Testing 76 Support the
Infrastructure 151
CHAPTER 9
Building Your
Future Body:
Physical Medicine 164
PART 3
When Lyme Reference Charts 222
Persists: References 233
It’s Time to Acknowledgments 246

Dig Deep About the Author 247
CHAPTER 10 Index 248

The New Normal:
Living with Chronic
Lyme Disease 179
CHAPTER 11
Energy Medicine:
Nurturing Our
Future Selves 206
INTRODUCTION
hronic Lyme disease and associated coinfections are creating a
C chronic disease juggernaut that is moving through both the human

body and our health care system, diminishing quality of life and
productivity while increasing medical costs.
The biggest risk factor associated with Lyme disease is the denial of treatment
rather than the disease itself. More than just a physical experience, Lyme disease
requires a level of medical savvy patients don’t even know they need until they try
to find treatment for a chronic condition that many believe doesn’t exist. Finding
appropriate, compassionate care is a game with a unique set of rules for navigating
the medical system and insurance coverage. But the stakes are high: Unresolved
tick-borne disease opens the door to a range of chronic health conditions that
are seemingly unrelated, including cardiovascular effects, hormone imbalance,
neurological diseases, autoimmune diseases, and premature aging.
How do we rise above Lyme disease? We become educated about what to
expect in the course of diagnosis and treatment, and we learn how to advocate
for ourselves. My motivation in writing this book is to offer a framework for
understanding the diseases ticks carry, related conditions that make recovery
more difficult, the sociological impact of tick-borne disease, the trauma
of trying to find help, and the range of complementary treatment options.
6 R I S I N G A B OV E LY M E D I S E A S E
Rising Above Lyme Disease is a guide for patients, family members, support
groups, and others, serving as a reference for treatment options, symptoms,
and approaches to preventing long-term complications.
When I first considered writing the book, I pictured a chronic Lyme
disease patient at home in the middle of the night, overwhelmed with fear
from symptoms so intense he feels a loss of hope leading to suicidal thoughts.
This scenario happens more often than most will admit. As much press as the
disease gets, people with the infection still feel that they are living in the
shadows, shamed for not getting well fast enough or accused of attention-
seeking behavior. The more we understand the barriers a Lyme patient is up
against, the more compassion we as a society will be able to give, and the more
we will understand that it takes time to heal.
Tick-borne infections require patients to dig deep and learn the self-care,
self-advocacy, and inner strength they will need to endure the long marathon
of recovery. If they lack self-love, have experienced trauma, or have a habit of
placing their needs lowest on the totem pole, they will find that these patterns
hamper recovery. Life stressors, mental or emotional imbalances, and negative
outlooks can be magnified during the treatment process. Neuroinflammation
created by the presence of spirochetes in the brain intensifies old emotional
wounds, fears, and traumas, which can dramatically slow the healing process.
This is why it’s so important to discuss psychospiritual aspects of the recovery
process, delving into energy medicine and tapping into the innate quantum
healing capabilities of the mind and body to enhance personal power, rebuild
the body, and experience a deeper level of self-awareness. The healing power
of the mind is substantiated by science daily, and it is a power we all have
access to. Integrating conventional medical methods with alternative and
energetic healing makes recovery more efficient. I have spent more than a
decade weaving together multiple modalities to support patients through their
journey to heal from tick-borne disease.
I am what is considered a Lyme-literate doctor with an integrative medical
practice. My bachelor’s degree is in psychology, and I thought I would
eventually earn my doctorate in that field. Before I entered medical school,
I worked as a case manager with at-risk populations in domestic violence
shelters, in suicide crisis management, and in rape victim assistance. The
skills I learned in my early twenties have served me well in my work with
patients in crisis with tick-borne infections. Eventually, my heart felt a pull
toward naturopathic medicine, and I happened to live minutes away from one
of the oldest naturopathic medical schools in the country, the National
University of Natural Medicine. Part of the fiftieth graduating class, I com-
pleted my doctorate in 2006 after four years of medical school, with a focus on
general family practice and environmental medicine.
7
I had always been drawn to mind-body medicine—even in my undergraduate
years—and recognized my own intuitive sensitivities in non-ordinary reality
since childhood. Many people with energetic sensitivities tend to keep them
quiet or dismiss them as fictional, but we all have the capacity to access our
energy in a more intuitive way. We all have the capability to explain that
energy away as well. To be authentic in the way I practice complementary
medicine, I discuss energy healing as a way of bringing it out of the shadows.
Naturopathic medicine provides a beautiful flexibility to blend science and
spirit. It’s an open playground for exploring all the holistic facets of medicine
with a foundation of science for diagnosis and treatment. And it embraces all
aspects of the human experience and honors the patient’s individual journey.
The tenets of naturopathic medicine serve as my compass daily as I work
with patients of all ages and from all walks of life. These tenets are:
• First, do no harm. This principle is about using the least invasive

measures to improve a person’s quality of life, working with utmost
safety and integrity. Unfortunately, with Lyme disease, discomfort
is often part of the healing process, but the goal is to support this
process with natural medicine and lifestyle choices that minimize
suffering.
• Identify and treat the cause. If the cause of an illness is not
addressed, it will be difficult to resolve the symptoms.
• Access the healing power of nature. Natural medicine is not just
about using herbs, nutrition, and homeopathy; it’s about tapping
into the innate intelligence of the body to heal when obstacles are
removed.
• View the doctor as teacher. My role as a doctor is to empower,
support, coach, and reflect compassion. Each patient is her own
doctor on a daily basis, making choices for self-care. I’m the person
who provides available options and gives guidance for making
necessary life changes to create optimal health.
• Treat the whole person. Naturopathic doctors are trained to see
the human body as a cooperative system instead of in parts. A
doctor serves patients best when she addresses the physical,
mental, emotional, genetic, environmental, social, and spiritual
aspects of their lives. Treating the whole person is about listening
to the complete story and understanding how to help the parts that
are out of balance.
• Support prevention. Our job as doctors is to work ourselves out of
a job by helping patients recover and avoid disease states. Preven-
tion is the deferment of disease throughout the course of a lifetime.
I have been a Lyme-literate doctor in service to those requiring care, but
I have been a patient as well. It took two years of antibiotics, herbs, homeopathy,
physical medicine, and, eventually, five months of intravenous antibiotics to
clear my tick-borne disease. My experience with healing modalities such as
shamanism, biofield therapies, and energy anatomy is what helped me finally
let go and achieve full remission. I was confirmed to have Lyme disease and
was also infected with Babesia duncani, a tick-borne parasite. Many patients
report feeling regretful and ignorant because they could not see the illness
clearly enough to take action at the beginning of the infection, but try being a
doctor who treats patients with tick-borne disease daily and having no idea
you had it.
I explained away my symptoms for months, blaming them on the sleep
deprivation that comes with having young children, a new practice, and not
enough time for self-care. I could barely get myself out of bed in the mornings
without feeling pain as well as vertigo. Cognition was difficult and I developed
seizure-like episodes, which were very alarming for my family. It’s been five
years since my recovery, and I have not required treatment since. This does
not mean I’m immune to being bitten again and reinfected—after all, I live in
New Hampshire, among the most infested areas in the country. Throughout
the process of healing from Lyme disease, I was lucky to have a medical
practice centered on tick-borne infection. I had a built-in support system, with
patients who offered compassionate words as I, while receiving intravenous
antibiotics, met with them about their own health care needs.
With Rising Above Lyme Disease, I look to support you as a Lyme patient,
or as a family member or friend of someone battling tick-borne illness, any
way I can. I not only want to help you in resolving your disease; I want to help
you realize you are not alone and we can stop the trauma cycles by becoming
more informed. Be well. Take what resonates for you and leave the rest to
follow your own truth.
INTRODUCTION 9
PAR T
1
D E M YS TI F Y I N G
TICK- B O R N E
DISEASE
CHAPTER 1
THE TICK:
NATURE’S
DIRTY
NEEDLE
y naturopathic medical practice is located in southern New Hamp-
M shire, one of the most tick-infested areas of the country and one
with a high rate of tick-borne disease. About halfway through writ-
ing this book, I went to work one day to find that eight follow-up
patients had canceled and rescheduled. This number of reschedulings almost
never happens in my office, but the coincidence brought in several very ill
patients who otherwise would have waited two to three months for an appoint-
ment. When we saw the cancellations, my amazing staff got on the phone to
call people on the waiting list, and within an hour we had three new patients.
They represent the types of new cases we see in a typical day at the clinic.
The first patient was in her thirties, and three years earlier she’d run the
Boston Marathon and worked full time in a successful career. She now
suffered with chronic complaints, with her main symptoms being chronic
joint pain, stabbing nerve pain, and widespread muscle pain. She reported that
she had once been a very balanced person but had struggled with obsessive
dark thoughts, anxiety, depression, and debilitating fatigue for the past two
years. She also suffered from chronic insomnia, brain fog, sweats, rashes, hair
loss, lumps under her skin, foot pain, and dizziness.
11
Her primary care provider (PCP) diagnosed her with anxiety and depres-
sion and prescribed medications for mood. When the patient asked her PCP to
look further into tick-borne disease, the doctor refused and told her she was
depressed due to her inability to have children. She asked several times to be
tested for Lyme disease and other tick-borne infections but was denied
because the doctor felt she was just depressed. After many visits to the doctor
trying to get help with her symptoms, the patient sought a second opinion. Her
lab work showed positive for Lyme disease, and we started treatment. By the
next visit, approximately eight weeks later, she reported significant improve-
ment in her mood as well as reduced pain, and she was back in the gym
running again. She is still undergoing treatment for some lingering symptoms,
but her quality of life has improved dramatically.
The second new patient of the day was a nineteen-year-old male who had
been an Eagle Scout and straight A student up until the day, two years earlier,
he woke up in the middle of the night with intense sweats and fever; he’d been
suffering from overwhelming fatigue ever since. He was tested at the time and
was positive for Lyme disease, but his doctor was unwilling to test coinfections.
He was treated with three weeks of antibiotics at the time of initial symptoms,
two years earlier. Any further treatment with antibiotics was denied.
The patient did see several specialists, including an infectious disease
doctor who told him and his family that he suffered from post-Lyme syndrome
and that he should go home to rest for the several months it would take to
recover. No treatment was offered. So, the patient followed that advice. He did
not graduate from high school, spent most of his days in bed, and was too
fatigued to shower on a regular basis. He made changes to his diet, which
helped the symptoms somewhat, but he was still not functional. He was
unable to read for long periods of time or retain information. Though this
patient has been to see many doctors and has tested positive for Lyme disease
more than once, he was never given antibiotics after the initial three weeks.
After being tested in my office, he was diagnosed as still having active Lyme
disease and was positive for Babesia microti. He is recovering, after starting
aggressive treatment, but because of his debilitation due to inactivity, he will
have a long road to regaining his strength. Full recovery takes, on average, six
months to a year, with each person’s path being slightly different.
The third patient was a ten-year-old girl who’d made several visits to her
pediatrician and the emergency room over a two-year span. She had several
episodes of intense abdominal pain and fevers over 104°F (40°C). She also
experienced chronic leg pain, headaches, and repeated sore throats with
significantly enlarged tonsils. The girl’s mother started to notice hair loss and
mood changes in her daughter as well. She had asked to have her daughter
tested for Lyme disease, but given the girl’s abdominal pain, she was referred
for a colonoscopy and ended up having exploratory abdominal surgery. Her
appendix was removed during the surgery, even though it was not acutely
infected. Though her mother had asked the pediatrician to test for Lyme in the
past, she was not tested by the doctor and was never screened during any of
her visits to the emergency room for a high fever. She was not tested for Lyme
disease until two weeks before presenting to my clinic. Her tests were positive
for Lyme disease, and we began treating her immediately.
These are three patients who were denied testing and treatment. Three
patients who underwent unnecessary medical procedures or were just
abandoned. Three patients who suffered because Lyme disease is not taken
more seriously. Each of these patients had been to see specialists, including a
neurologist, a gastroenterologist, and infectious disease specialists. I’m sorry
to say that this is not an unusual occurrence for those who come to my clinic.
Lyme Disease:
You Don’t Get It until You Get It
You probably bought this book because you or someone you love has been
diagnosed with a tick-borne disease. Arriving at an accurate diagnosis may
have been a difficult journey. Perhaps you saw several doctors, chasing
symptoms, and were given several diagnoses; meanwhile, you collected a
binder full of lab reports and just wanted someone to listen to your story and
put the pieces together. Your story might involve symptoms that come and go
on a day-to-day basis, or even minute to minute. You might be fine in the
morning and bedbound with pain by lunchtime. You might need people to
understand that the light shines too brightly in a room or a sound is too loud,
making it impossible to complete a trip to the grocery store. You may go to
work every day, wondering if brain fog will cause you to make a mistake. Or
you hand your young child the iPad more often than you like because you are
too sick to be the active parent you envisioned.
For most people, the symptoms of tick-borne infections don’t end up on the
radar until the complaints are persistent and undeniable. The most poignant
statement I hear is, “You don’t get it until you get it.” So, how do we “get” it?
Learning how to advocate for yourself is important. You’ll need to know how
to weed through the polarized views around Lyme disease and be at peace
with the process of healing. My goals with this book are twofold: to address
prevention of acute Lyme disease and to focus on the physical, mental,
emotional, and spiritual aspects of chronic tick-borne disease.
T H E T I C K : N AT U R E ’ S D I R T Y N E E D L E 13
Chronic Lyme disease can mean big changes in daily life, affecting family
structure and your ability to work. It can significantly decrease quality of life
by compromising your ability to care for yourself, and it can manifest emotional
trauma. Lyme disease is a unique illness that is present in broad daylight; we all
know it’s there and represents a problem, yet those who are sick may feel the
need to hide their experiences. Most of the fear and shame patients feel, sadly,
comes from their interactions with the medical profession. Healing happens
when patient-doctor relationships are healthy and when patients feel sup-
ported, believed, and safe in being honest about their health concerns.
The doctor may not even be aware that a breakdown in communication is
causing harm, but politics can take over, especially if the patient happens to
live in an endemic area such as the Midwest and northeastern United States.
The Centers for Disease Control acknowledge that Lyme disease exists, that
we all need to take preventive measures to avoid tick bites, and that treatment
should follow if a patient walks into a medical office with a bull’s-eye rash. Far
too often, however, patients are sent away having been told that the tick was
not attached long enough to cause a problem or that they should wait to see
whether symptoms develop. If conventional treatment is administered, it’s
rarely adequate, in my professional opinion. Typical treatment time for a bite
or suspected bite is ten to twenty-one days of an antibiotic (and sometimes
only one dose of doxycycline is given), with patients being refused treatment
for longer even if they are symptomatic.
I belong to a group called the International Lyme and Associated Disease
Society, affectionately referred to as ILADS. It is a collection of practitioners
from around the world who believe that Lyme disease can persist and requires
longer treatment time in cases where symptoms continue. Treatments are
usually a combination of antibiotics to combat infection and natural medica-
tions to enhance quality of life. My practice involves both forms of treatment,
and the plan is individualized based on what is best for the patient. The
approach used in conventional medicine must change—and it will—but it will
take time to dismantle the current belief system that chronic Lyme disease is
not treatable. In the meantime, doctors who acknowledge the complexity and
individual needs of healing from tick-borne disease are here to help.
One of the biggest risk factors for developing chronic tick-borne disease is
a delay in treating the acute infection. Chronic Lyme disease is a complex
infection that is treatable, but mainstream medicine has put forth a belief that
patients must just live with “post-Lyme syndrome” with no solution.
I see the Lyme disease crisis as man-made, caused largely by the medical
community’s refusal to treat acute Lyme disease effectively and its denial that
chronic Lyme disease exists at all. In addition, human interaction with the
environment is creating widespread changes in the climate and ecology that
are favorable to tick propagation. Tick-borne diseases are treatable if caught
early and treated adequately—and by “adequately,” I mean until the infection
is resolved. Not when we say it should be resolved, but when the person has
recovered in his own unique time. Specific medications and modalities may
change throughout the treatment process, but it is critical to stick with a
process until the infection resolves. Don’t give up! The longer treatment is put
off, the more difficult it is to regain optimum health.
When you discover a tick bite, take action and find a practitioner to treat it.
You need to treat every tick bite as if the tick was infected. In geographic areas
with high tick infestation, patients should be tested yearly for Lyme disease as
part of their regular health screening. After all, if you were walking on the
beach and stepped on a hypodermic needle, you would be treated with
antiviral and antibacterial medications for at least thirty to sixty days to
combat the worst-case scenario. A tick, attached for several hours or days, is a
nature-made hypodermic needle.
Some people are cavalier about tick bites, just pulling ticks off and discard-
ing them without a second thought. This is most common among people who
have been exposed to ticks throughout their lives without perceived conse-
quence. However, the number of infected ticks has exploded in recent decades,
and we cannot count on a tick bite being harmless. Given the microbial
diversity in the environment, I assume that every tick is infected. Unfortu-
nately, many patients with new bites are turned away from medical clinics and
come to see me months later, sick and angry that action was not taken sooner.
They wish they had known how to better advocate for themselves.
One problem is that a large percentage of patients don’t remember getting
a tick bite; finding a tick on their body might have spurred them to go to the
doctor right away. I have never seen a tick on my skin, but I have had two
confirmed infections. If a patient is lucky enough to notice the bite and find
the tick that bit him, he may not have immediate symptoms that prompt him
to seek medical care. Whether tick-borne disease is acute or chronic, treating
it is critical. Every day, I see patients regain a better quality of life with
treatment. In some cases, the road can be long and bumpy, but it’s important to
be open to all treatment options, be patient with the process, and be willing to
make changes in your life that align with healing mind, body, and soul.
The Life and Times of a Tick

When I give lectures describing what happens when a tick bites a human,
people start to itch and squirm. It is not pleasant thinking about insects on your
body, but if it makes you feel better, ticks are not considered insects. They are
arachnids, in the same family as spiders, though more closely related to mites.
Growing up in Portland, Oregon, I didn’t have much exposure to bugs. There
were some spiders, potato bugs, worms, and the hugest slugs you can imagine.
Compared with New Hampshire, Oregon was a cakewalk. I was the typical city
girl who was schooled quickly when I moved to the New England countryside,
with its ticks, mosquitos, black flies, fire ants, and the green horseflies that
literally take a chunk out of your skin. When I first moved to the Northeast, I
was even scared of dragonflies, though now they are one of my favorites.
Although people know ticks carry Lyme disease, they typically don’t know
ticks can also transmit other diseases. And most don’t know much about the
life of a tick. Understanding the life cycle and tendencies of ticks can help you
protect yourself. Ticks live all over the world, with different species having
evolved to survive in their particular environment. The most common
tick-transmitted infections in the United States are from Ixodes scapularis,
also known as the black-legged tick or the deer tick. It lives one to two years
and has three physical stages of maturation: larval stage (newly hatched);
nymph stage, which is the tick’s adolescence period; and adult stage. Ticks rely
on blood meals to grow into a new stage of development.
Ticks have been feeding from hosts for more than 300 million years.1 The
species vary depending on location, with Ixodes scapularis most commonly
found in the northeastern and north-central areas of the United States and up
into Canada; Ixodes pacificus is typically found on the West Coast in the
United States as well in British Columbia; Ixodes ricinus occurs in Europe;
Ixodes persulcatus is found in Europe and Asia 2; and other species of Ixodes are
found throughout Asia.
Ixodes scapularis is referred to as a hard-bodied tick because of the
presence of a hardened cuticle that covers the entire body of a male tick and
one-third of the body of a female, giving it the common two-toned elliptical
shape on the back. Female ticks, larvae, and nymphs have the ability to grow
tenfold in size, in both length and width, with each feeding. The male tick
stays fairly small as it feeds because of its denser outer covering. 3 One of the
most interesting facts about Ixodes is the minimal time the tick spends feeding
in its lifetime. Only two to three weeks of a tick’s typically 108-week life is
spent actively feeding.4 Compared with other parasites, ticks spend little time
attached to their hosts, feeding only during yearly growth phases and the
active reproduction phase in the female.
Newly hatched ticks are barely visible to the naked eye; they have a shape
similar to that of an adult tick, with two fewer legs. These are usually free of
infection but acquire infections from feeding on small rodents. However, the
newly discovered strain of the bacteria Borrelia miyamotoi can be passed from
a female tick directly to her larvae, in a process known as vertical transmission.
This is the first time vertical transmission has been seen with tick-borne
pathogens; this type of transmission will make controlling infection rates
within the tick population more difficult, and the infection is likely to spread
more aggressively among the population. Tests available from IGeneX and
other specialty labs can now identify this strain.
The nymph stage is the most difficult to identify because the ticks are
small enough that they are indistinguishable from specks of dirt. You wouldn’t
feel them walking on you and brush them off, and this stealth means they are
also the most dangerous. They are the reason most people have no idea they
have been bitten. An adult tick can be the size of a poppy seed. The strain of
Lyme or other tick-borne disease a tick carries will depend on the species
of tick and its geographic location. Certain strains of Borrelia (the genus of
bacteria that includes the species that causes Lyme disease) are more apt to
present with neuromuscular symptoms, while others are more likely to have
relapsing fever as a symptom.
Ticks exemplify patience. They will wait months or years to feed. Their
primary method of detecting a host is their sense of smell, which is far beyond
that of the keenest bloodhound. This heightened sense of smell is critical
because they do not have strong vision or hearing. They can detect carbon
dioxide and lactic acid emissions from a host and can smell odors from
microbial colonies on a person’s skin. This may be the reason that certain
people seem to be tick magnets, getting bitten more often than others.
Ticks do not move quickly but have amazing reflexes that allow them to
grab on to a host as it walks by. Once a tick has found a host, it searches for an
ideal place to feed. Because they are not fond of light, they will usually pick a
place on the human body that’s covered, such as the hairline, under clothing,
or in areas better left to the imagination. Trust me, ticks can (and do) attach
anywhere you can imagine. To feed, they use their legs and mouths to anchor
themselves onto the skin. They project a jagged, razorlike appendage, making
a slice in the skin where they insert their mouths to make contact with small
blood vessels. Then the meal begins.
More than half of my patients with a confirmed tick-borne infection have
no memory of a bite. This is because ticks prefer locations in areas not readily
seen. They also release anti-inflammatory and analgesic substances in their
saliva, which allows them to remain attached unnoticed. Ticks’ survival
depends on their ability to avoid being noticed and maintain hydration when
they are not feeding. This is why areas with higher humidity and rainfall are
more apt to have larger tick populations. Ticks are not sun worshippers; they
prefer warm, overcast, humid days, hanging out on a blade of grass “questing”
for their next meal. They maintain proper fluid balance in a variety of ways,
absorbing moisture from the environment, retaining water via their waxy
coating, and tightly closing body openings to reduce water release.
The tick’s need to maintain moisture is also important in the transmission
of disease. Over the course of hours or days, the rates of ingestion of a blood
meal will vary; sometimes they feed faster and other times more slowly. Ticks
need a way to manage the flow of fluid. While feeding, their salivary glands
release excess fluids by regurgitating blood meal and midgut microbial content
into the host, which is when infections are transmitted. The tick’s midgut has
a low enzyme content, which allows microbes to live there without being
degraded, as food would be in the human stomach.
Ticks have a well-equipped immune system, which gives them the ability to
kill invading microbes. A lot of the same processes are used by humans;
however, certain pathogens have evolved to evade ticks’ immune systems as
well as humans’.5 Tick saliva has many proteins that are currently being
studied and analyzed for their role in the transmission of infection. These
proteins reduce inflammation and pain at the bite site and also contain
anticoagulants that prevent clotting of the blood in the host, enabling the tick
to maintain a continuous flow of blood meal. The saliva proteins reduce
immune mechanisms in the host that would ordinarily promote wound healing
and attract cells to the area that would bring the host’s attention to the site.6 If
this happened, the tick would most likely be removed by the host. These
mechanisms have all evolved over time to enable the tick to stay attached, using
its own internal medications in the form of anti-inflammatories and anticoagu-
lants to maintain connection long enough to eat. Meals are few and far
between, so ticks need to make the most of the time they are attached to a host.
Tick Attachment Time

Tick attachment time is a hot topic, and this is where politics are involved.
There is much debate about how long it takes a tick to transmit infection.
Many doctors tell patients that if a tick was not attached for at least twen-
ty-four to forty-eight hours, they can throw the tick away because there is
nothing to worry about. I never understood this logic. The longer a tick is
embedded, the greater the risk; but ticks can transmit disease in even a short
period of time. Research has shown that Powassan virus can be transmitted
within fifteen minutes of a bite, while anaplasmosis and Borrelia miyamotoi
can be passed within twenty-four hours of attachment time.7
The other issue is that a partially fed tick may be disturbed and drop off
one host and then reattach to a new host almost immediately, posing a greater
threat of infection in a short period of time. This is because, as a tick feeds, it
upregulates migration of spirochetes into its salivary glands, making them
transmissible. If a tick feeds on an animal or human
but is removed before finishing its meal, it may
quickly reattach to another host to continue the
The longer a
blood meal. It is then able to transmit infection soon tick is embed-
after attaching because the spirochetes have already ded, the greater
worked their way to the tick’s salivary glands. Due to
the risk; but
the many unknowns of the tick feeding process, the
safest choice is to assume infection was transmitted,
ticks can trans-
even if the attachment time was brief. mit disease in
Few people would witness the exact moment a even a short
tick implanted and think, “I’ve got a day or two until
period of time.
this becomes a problem, so let’s leave it.” When a tick
is found, a person usually does not know the specific
moment it attached—he makes an estimate. Tick attachment time is not the
most reliable criterion for determining infection because the skin is numbed
by the tick at the time of the blood meal, and the person doesn’t feel the bite.
There are also many variables that increase the chance of infection during
attachment, such as friction or pressure applied to the tick unknowingly by
clothing or body movements. This can agitate the tick, which increases blood
regurgitation into the host, transmitting infection. There are also other
differences that come into play: the particular infections an individual tick
carries, the protein makeup of that tick’s saliva, the blood vessels it is able to
tap into (which affects proximity of infection), and the host’s immune system
and skin thickness. Taking all of these variables into consideration, it does not
make sense to assume the patient is in the clear.
You need to advocate for yourself to get a bite treated as soon possible. Also
understand that, just because you do not see a bull’s-eye rash—a red ring around
the lesion—it does not mean you are not infected. A number of factors go into
determining the disease process, and many who are infected do not get a rash,
or indeed any symptoms, at the time of the bite. Instead, over weeks or months,
their health slowly deteriorates, with confusing symptoms that seem unrelated
to a tick bite. This leads to many appointments with specialists, invasive testing,
and treatments that are not appropriate for the actual cause of the symptoms.
Ticks and the Environment

An ideal tick environment is shady and moist and is also home to small
animals on which the tick’s young can easily feed. The white-footed mouse is
the primary source of infection for the larval tick because, being low to the
ground, it’s easy to attach to. These mice like to live in wood piles, leaf litter,
and crevices of buildings, just as ticks do. The overall population of rodents,
including chipmunks, squirrels, and voles, is increasing due to the warming
climate and a decrease in birds of prey that would normally reduce rodent
populations. Loss of habitat and viral infections have led to a significant drop
in birds of prey over the past decade. Birds play a major role in transporting
ticks across vast areas of the country, making it possible to encounter ticks
even in New York City’s Central Park or other cityscapes. With the aid of
birds, ticks become mobile—like humans on a plane ride.
Trees play an important role as well by providing a food supply that lets
small rodents (which transmit infection to the tick) survive a harsh winter. An
increase in acorn production from oak and beech trees, called a mast year,
seems to be happening more often in recent years. Several theories to explain
mast years exist. The most plausible is that the trees’ reproductive cycles take
a lot of energy, so they save that energy for a larger release periodically, to
ensure the tree’s survival. Depending on the year, weather patterns are a
driving force for bumper crops. The year after a mast year correlates to a boom
in the tick population. In a study reported in Natural Areas Journal, research-
ers found that six oak trees and one hickory in Long Island, New York,
experienced a mast year for three out of five years between 2007 and 2011. 8 It’s
not typical to have so many, but changing weather patterns in recent years
have led to many events that weren’t experienced ten to twenty years ago.
Although the white-footed mouse has been getting more attention because
it is a well-known carrier of Borrelia species, most people associate Lyme
disease and ticks with the deer that free-range in their backyards. Deer can
carry thousands of ticks, usually adults or those in the nymph stage. Many
areas are overpopulated with deer because of an imbalance of predator and
prey and because of human sprawl in their migration paths. Deer and other
wild animals do not want to be in our backyards, but with human development
proliferating, they are running out of places to go.
There is also a big problem with moose dying off, being unable to repro-
duce, and collapsing because of blood loss from too many tick attachments.
The warmer climate and increased tick activity have caused moose to experi-
ence thousands of tick attachments, which are creating anemia in the moose
cows (females). Historically, these animals follow cold weather, moving
northward in summer, and are not in infested areas at peak tick feeding time.
Because of climate change, the areas they commonly migrate to have
increased in temperature, allowing ticks and rodents to survive more readily.
Deer rub against trees to scrape ticks off, but moose have not yet learned
this behavior. Severe blood loss is reducing the ability of moose cows to
become pregnant and to deliver and feed healthy calves. In 2014, New
Hampshire Fish and Game launched a study of moose populations in New
Hampshire, Vermont, and Maine to determine the impact of changing weather
patterns, along with the impact of tick attachment, on the ability of moose
cows to deliver healthy calves.9 Tracking collars were placed on animals and
blood samples collected to assess the health of the moose population. While
numbers are reduced, the population has not yet reached the brink of destruc-
tion. It will take several years of data collection to understand the relationship
between changing weather, ticks, and moose calf production.
Ticks Have No Downtime

Tick bite season is spring and fall. During these seasons, my office typically
receives five calls per day about new bites. Fitting patients in right away is very
important to me because the initial bite is such a sensitive time for addressing
the infection. At peak season, my staff have the joy of seeing baggies and
containers of ticks hanging out at the front desk more than they would care to.
I have been specializing in Lyme disease for more than a decade, and over the
past five or six years, tick bite calls have been growing steadily. The seasons
are becoming more variable, with warmer temperatures giving the ticks more
time to feed.
In 2015, in New Hampshire, we were gifted with a 70°F (21°C) day on
Christmas, which was fun and weird at the same time. The following business
day, we received calls for tick bites, an odd thing to treat in December. Ticks
can withstand intense temperature variations and often survive best when
there is a good snow pack to provide them with insulation. Deer ticks are still
actively feeding in freezing temperatures, though other species may go
dormant or burrow underground in the winter months. Ticks are more
aggressive upon waking up in spring and getting ready to go dormant for
winter, but a bite can happen any time of year.
Protecting Yourself from Ticks

You can make changes in your own environment to reduce your tick exposure.
The most important step you can take is to modify the landscape of your yard:
remove leaf litter; move recreational equipment such as swing sets out of
shaded areas; thin excess brush to allow more light in; keep wood piles away
from the house; reduce deer-attracting shrubs on the property; and monitor
pests, such as mice, within the house. Clearing excess brush and leaf litter gets
rid of the ideal nesting and breeding ground for rodents, reducing tick nests,
too. Ideally, shrink nesting ground for mice, squirrels, chipmunks, and voles.
Placing bird feeders away from the house prevents ticks from dropping off
birds into your yard and keeps at a distance the rodents who love to find ways
to get into the feeders. For natural tick control in your yard, consider keeping
chickens or guinea hens; these birds are ideal because they will devour several
hundred ticks in a day. Chickens can clear ticks from around the house, while
guinea hens prefer to spend their time in forested areas and will range in more
tick-infested areas.
Another way to prevent tick bites is to use permethrin, an insecticide similar
to a compound found in chrysanthemums. A neurotoxin for insects, it can be
dangerous if used on human skin for prolonged periods. In minimal exposure,
permethrin is reported to be nontoxic. Typically used topically for short courses
of treatment for lice or scabies, it’s commonly marketed under the brand name
Nix. The best option for tick-bite prevention is to send personal clothing for
treatment to a company such as Insect Shield or to purchase permethrin and
apply it to clothing that will be used only outdoors when you need protection.
This product is not meant for direct contact with the skin. Companies such as
Insect Shield guarantee effectiveness up to seventy washes, so treating two to
four outfits will get you through a typical spring to winter season.
While I was speaking at an event for the Holistic Mom’s Network, a fellow
panelist noted that she started educating her children early about ticks and the
importance of changing into “special” clothes when they wanted to play
outdoors. She told them they could get as dirty as they wanted but they needed
to take the clothes off as soon as they were finished playing to have a bath or a
tick check. She left separate totes by the door for each family member’s treated
clothing. Such clothing should be marked, kept separate, and washed sepa-
rately. Having specially treated outfits has been important for my patients who
work at jobs that expose them to ticks daily, such as in landscaping, forestry, or
surveying, and for those who work in the elements to maintain public utilities.
Most people prefer to have their garments professionally treated at a
modest cost rather than handling the chemicals themselves. There is much
concern about using chemicals topically, especially with children because of
their relatively low body weight. I typically recommend using permethrin-
treated clothing or spraying commercial topical insecticides on clothes and
applying more natural substances to the skin. I make that same recommenda-
tion for both adults and kids—we are never too old to take precautions as if we
were newborns.
Consumer Reports performed rigorous studies with uninfected ticks and
mosquitos to see how effectively each brand of the topical sprays available in
the marketplace repelled ticks. The three most effective options were DEET at
concentrations of 15–30 percent; Picardin by Sawyer at a concentration of 20
percent; and Lemon Eucalyptus Insect Repellent Spray by Repel at 30 percent
concentration. The first two are chemical-based products, and the third is
marketed as an essential oil compound. Note that the concentration of the
active ingredient is important: The study found that if it went below the
threshold indicated, potency was dramatically reduced, but if it was too high,
the product posed toxicity risks.
Applying topical sprays, wearing treated clothing in light colors, tucking
pant legs into socks, and wearing hats (with longer hair pulled up under the hat)
can help you repel ticks or notice them so you can remove them before they
attach. A tick is not an aggressive creature in that it is not fast moving. It is
harmless until it attaches to your skin. The most effective preventions are
protecting your body as mentioned above and performing regular tick checks—a
meticulous inspection of the body, including the scalp, for ticks. You can also use
a lint roller on you or your pets to remove ticks. If possible, shower and wash
clothes immediately after coming home from potential exposure. Stay away
from poorly manicured paths and tall-grass areas, especially near water.
Tick tubes are another popular method used by my patients because they
minimize the need to spray chemicals in the yard. You can make these easily by
spraying permethrin on cotton balls and placing them into old toilet paper rolls.
The idea is that mice take the cotton to their nest, which kills any ticks before
they attach to the mice. Based on a data search, this method was tested by
comparing the tick count in an area treated with tick tubes and an area without.
Unfortunately, there was not much of a distinction in tick population in the
treated group compared with the untreated group over a two- to three-year
period.10 Note that permethrin is not selective in the bugs it kills; it will also kill
pollinators such as bumblebees that make their nests low to the ground.
Sprays to treat your yard and lawn are helpful in reducing the chances you
will pick up ticks. I promote the organic options for reduced toxicity to plants,
pollinators, humans, pets, and wildlife. The organic formulations use syner-
gistic combinations of essential oils (peppermint, rosemary, and geranium)
together with low amounts of natural pyrethrums found in chrysanthemums
as a more close-to-natural option than straight permethrin. You still run the
risk of hurting pollinators, but you have the best chance of minimizing that
risk with an organic spray. I am a beekeeper, so I am keyed into this issue on
my one acre of land. Check your local listings for pest services that are
attentive to managing pests while reducing the impact on other species of
insects and on animals and humans.
There is also a garlic spray called Mosquito Barrier, which you can purchase
online or in retail stores. The odor of the garlic is supposed to deter mosquitos and
ticks. This method requires repeated treatment throughout the summer because
the odor dissipates over time. I have seen better results and fewer treatments
required when organic formulations consisting of essential oils and plant-based
compounds of pyrethrum are applied by local pest control companies.
As you work to reduce your exposure to ticks, you need to consider how you
will control ticks on your pets. Dogs and cats are big risk factors in humans
acquiring tick-borne pathogens. I love animals and have been a pet parent all my
life, but living in an area where ticks are so prevalent has changed my comfort
level with having a pet. Most of my patients have an animal that goes inside and
out. Cats allowed outdoors tend to pose greater risks because they venture into
the brush and travel farther from home than dogs. However, cats are more easily
trained to remain inside because they can use a litter box. They may not like it at
first, but indoor confinement for your cats could make the difference in whether
you and your family get sick. Cats that go outside may also present greater tick
control challenges because they typically do not undergo tick checks willingly.
Patients have been swearing by the Seresto collar for their dogs. These
flea- and tick-repellent collars have an eight-month protection period. Dog
owners report few to no ticks compared with previous years. Tick repellents
for cats are not easy to find because of the need to balance effectiveness and
safety—the product must keep ticks away yet be nontoxic to the cat, which is
difficult because of their smaller size.
Stay Calm and Tweeze On

Most of my patients don’t remember being bitten, nor do they have significant
evidence of symptoms immediately. If you find the tick that bit you, you’re
lucky, because you can take action. A wait-and-see approach is risky given the
number of infected ticks in the environment. In my practice, every tick is
considered infected unless its test returns clean. In many debilitating cases of
chronic Lyme disease, it’s not just one bite that caused infirmity. Even though
the patient may remember only one bite, other ticks could have attached
without the person being aware of it. Over the course of time, with each new
bite, the body burden of infection grows; eventually, the infection gets to a
tipping point and the body starts to show significant symptoms.
If you find a tick embedded, stay calm and resist the temptation to
destroy the tick out of panic. Take a moment and gather the necessary tools:
tweezers or another removal instrument such as a tick scoop; a resealable
plastic bag; topical antibiotic ointment; and an adhesive bandage. Then
follow these steps:
• Remove the tick. The best tool is a pair of tweezers or tick scoop.
Some tweezers even have an attached magnifying glass that helps
you see more closely. A tick scoop—a small spoon with a slice in
it—acts like a hammer removing a nail. Using whichever tool you
have (even if all you have is your fingers), carefully yet assertively
remove the tick. Grip the tick as close to the skin as possible and try
to remove it with one pull rather than repeated tugs. If the head
and mouth parts are left in the skin, do the best you can to remove
them. This might not be feasible without causing more trauma to
the skin, in which case you can visit a doctor to have it removed.
In most cases, the tick will naturally come to the surface of the
skin to be released. Follow up with a topical antibacterial ointment
on the site of the bite. The most important thing to remember is to
not stress the tick with irritating substances such as garlic, kero-
sene, essential oils, repeated pulling, or pressing a blown-out match
to its body. This will just agitate the tick to the point that it might
transmit more infection by regurgitating the microbes in its gut
into the bloodstream. Keep a kit for removing ticks in the house.
You can purchase assembled kits that have the tweezers, container,
and wound care included (the one I commonly use in my office can
be purchased from Mainely Ticks). These kits usually come in small
packs you can keep in the medicine cabinet or in a backpack.
• Save it. After you remove the tick, ideally alive or in one piece, save
it in a plastic container or a small plastic bag. You do not need to add
anything to the bag. Do not place the tick in alcohol, or the bacteria
may not be testable. Alcohol kills or denatures proteins. If you have
the tick removed at the doctor’s office, specify beforehand that you
want to keep the sample for testing. Otherwise, the practitioner who
removes the tick might toss it in the garbage right after removal. It
used to be more common practice to save the tick and have it tested,
but currently many medical clinics don’t seem to advocate for this.
• Test it. There are a lot of data in the tick, which provide clues to
what might have been transmitted and help dictate the most
effective treatment. Turnaround time for test results of a tick is three
to five days, while it can take ten to fourteen days for your blood to
show signs of infection with the tests currently available. You can
send the tick to a lab and have testing done rapidly and affordably.
For instance, in the New England area, TickReport (www.tickreport.
com) offers testing through the University of Massachusetts. (Check
with your state; some offer free or reduced-cost programs for
testing.) You can also use a private lab, if you prefer.
Depending on the facility that performs the test, there are
different panels to choose from, ranging in price and the number of
infections tested. The most common panel screens for strains of
Borrelia, Babesia, ehrlichiosis, anaplasmosis, Rickettsia, and tulare-
mia (I discuss testing further in chapter 4). Depending on how many
bites you get in a given season, it may or may not be feasible to test
every tick. I have had ticks attached to family members tested and
found the testing helpful—the labs offer real-time email updates as
the tests for each infection are completed.
• Treat it. This step gets tricky because there are strict regulations
about what constitutes a treatable case in most hospital systems.
Guidelines are restrictive. If the tick test is positive for an infection, I
would advise you not to take the result lightly. Many doctors prefer a
wait-and-see approach; however, I would recommend treatment that
lasts at least four to six weeks to avoid being on antibiotics long term
in the future. You may think four to six weeks is long term, but this is
nothing compared with the treatment time for infections that have
had time to get more integrated into the body.
In my office, antibiotics paired with probiotics are the standard of care.

I also commonly provide homeopathic remedies to support the system in
clearing the infections. If you are not comfortable with the use of pharmaceu-
tical antibiotics, I discuss herbal protocols with intensive dosing schedules
and homeopathic nosode therapy in chapter 8. When it comes to a new bite,
antibiotics blended with natural medications are the most effective way to
avoid future stress. You will recover from taking antibiotics if you also take
the proper probiotics to protect your gut microflora and other natural medica-
tions to support your immune system.
In Summary
Ticks are not going anywhere anytime soon. The better we understand the
behavior of these little arachnids, their interaction with the environment, and
the importance of protecting ourselves from bites, the better we will be at
reducing transmission of tick-borne infections. Taking proper precautions by
wearing permethrin-treated clothing while playing outdoors or hiking in
endemic areas and using tick repellent on ourselves and our pets will signifi-
cantly reduce the chances of being infected or affected long term by tick-borne
infections. Even if you take all proper precautions, you may still suffer a bite.
In that case, immediate treatment can make all the difference in the path your
health takes. Remember, ticks are only a problem when their bite penetrates
the skin; other than this, they are harmless.
In the next chapters, we will take a more in-depth look at the bacterium
that causes Lyme disease as well as other common infections carried by ticks.
I will talk about other infections carried in the body that make recovery from
tick-borne disease more difficult, and I’ll discuss natural treatments and
common antibiotics used to combat this complex illness. The more we under-
stand, the more we are prepared to take action and receive proper treatment.
Antibiotics Vilified
I WENT INTO NATUROPATHIC MEDICINE to help people avoid taking medica-
tions, but I was raised around pharmacies and spent “Take Your Daughter to
Work” days with my dad, sitting on a stool as he dispensed medications. Eventu-
ally, I worked as a pharmacy technician through college. Shortly after graduating
from medical school in 2006, I moved from Oregon to New Hampshire to start a
medical practice focused on environmental medicine and general family practice.
Soon, however, patients started to show up debilitated with Lyme disease.
Early in my practice, I did not want to be involved in prescribing antibiotics, so
I referred patients to a primary care provider for treatment. Patients would
promptly return to my office, saying their doctor refused to write a prescription
because they could not possibly have Lyme disease. So, I grudgingly started to
write prescriptions for antibiotics. I saw people improve with a blend of natural
medications and antibiotics. We doctors have a saying: “Your medical specialty
picks you.” Clearly, providing care in a Lyme-endemic area with a doctor
shortage is mine.
Antibiotic use is a hot topic, and antibiotics once prescribed like candy are
now vilified. Somewhere in the middle is the right approach for medical
management of tick-borne infections. Antibiotics are not ideal solutions, but
when used judiciously, they can make a positive difference. It’s common for
patients to feel trepidation about using antibiotics due to the drugs’ impact on
the gastrointestinal tract, the patients’ medication sensitivity, and a general
desire to take as natural a course as possible. I always respect the patient’s
choice, and natural medications may be exactly the right answer.
More often than not, I have seen patients improve their quality of life with
the use of antibiotics, natural medications, and other healing modalities as they
recover from Lyme disease. Try to stay moderate in your view, trust that
recovery takes a while, and ingest those probiotics to reduce the digestive
distress and secondary gut infections associated with antibiotic use. (I discuss
probiotics in greater detail in chapter 7.)
CHAPTER 2
DIVING
DEEPER
INTO
CHRONIC
LYME
DISEASE
yme disease receives a lot of attention in the media and not enough
L during a typical doctor’s visit. The disease was named after the town
of Lyme, in Connecticut, where in the 1970s several children devel-
oped joint pain, fevers, rashes, and other symptoms thought to be a
viral infection. In 1977, before the microbe was identified, Allen Steere, M.D.,
identified Lyme disease as a vector-borne illness transmitted by ticks. Most
common diseases are transmitted through the air or via contaminated food or
water. Vector-borne illness requires a carrier such as a tick, flea, or mosquito.
A vector is an intermediary that passes infections—when ticks are the vector,
infection is transmitted to the next animal during a blood meal.
In 1982, Wilhelm “Willy” Burgdorfer, Ph.D., a medical entomologist,
identified the spirochete (a spiral-shaped microbe) responsible for the Lyme
infection. The spirochete then was named after him: Borrelia burgdorferi.
According to the International Lyme and Associated Disease Society (ILADS),
there are five subspecies of B. burgdorferi, with more than one hundred strains
in the United States and more than three hundred strains worldwide. Typical
testing to confirm Lyme disease looks only at one strain, with specialty
laboratories looking at two to four strains. This means that testing is limited in
its ability to absolutely rule out Lyme disease.
28
Lyme Disease Is Not
a New Epidemic
For a 2017 study published in Nature Ecology and Evolution titled “Genomic
Insights into the Ancient Spread of Lyme Disease across North America,”
researchers did genomic sequencing on 146 genomes of B. burgdorferi and
found that its most recent ancestor is more than sixty thousand years old. The
strains active now were present at least twenty thousand years ago in North
America. Remember this the next time someone tells you Lyme disease was
not around before the 1970s.
According to the researchers’ hypothesis, the reemergence of infection
started approximately seven hundred years ago with colonization, deforesta-
tion, hunting, increased deer population, and climate change. They found no
co-evolutionary relationship between the ticks and B. burgdorferi, but the
population of Ixodes scapularis (deer ticks) should obviously be watched to
track the presence of infection. It is uncommon for a host, in this case the tick,
to have no mutually beneficial relationship with a microbe such as the
spirochete. The tick serves only as a transport vessel for the spirochete
without deriving any benefit from doing so.
Based on the movement of the infection over its twenty thousand–year
history, it will continue to expand in all directions beyond North America.1
The researchers’ conclusion about the increase in Lyme disease over several
centuries makes sense given the change in climate patterns over the past
several decades, which coincides with the explosion of infected ticks. Lyme
disease is present in the United States, Canada, Europe, Asia, and Australia.
The most infected and infested areas of the United States are the New
England area, New York, New Jersey, Pennsylvania, Maryland, Delaware,
Wisconsin, and Midwestern areas, specifically Minnesota and Michigan.2
There are also growing numbers of infections in Oregon, California, and
Southern states, where many believe Lyme disease is not present. This myth
makes it even harder for patients to receive treatment in states where the
medical community believes there are no infected ticks and thus little to no
risk of Lyme disease. TickReport has an ongoing Tick-borne Diseases
Passive Surveillance database that shows reports of the diseases found in
ticks tested from forty states in the United States and Canada. The number
of ticks tested is always changing, but the most prevalent infections by
percentage are Lyme disease (both arthritis and relapsing fever types),
anaplasmosis, and Babesia microti. 3
29
Who Counts?
IT’S HARD TO DETERMINE THE NUMBER OF PEOPLE infected with tick-borne
diseases because data-reporting criteria are limited. Only those who reported
a tick bite within six weeks of a positive Lyme disease Western blot (an
antibody test used to diagnose Lyme disease) are factored into the numbers
reported to the Centers for Disease Control and Prevention. Although the
bull’s-eye rash is considered the cardinal symptom, very few people develop
this classic indicator. Reactions on the skin can be different, depending on
the immune response at the time of the bite.
Rashes can be big and have concentric rings, but they can also be small, with
just a slightly darker ring around the bite. Most of the time, however, there is
nothing but a pinpoint lesion where the tick punctured the skin. The bull’s-eye
rash around a bite, when it does occur, is created by the spirochetes migrating
through the tissue, away from the entry point into the body to find a suitable
location, ideally one with low oxygen, low blood flow, low temperature, and
sugar proteins. The presence of the ring is dependent on the host’s immune
system and the migration of the spirochetes. Given the number of variables
involved in developing a rash and the number of people who don’t show this
symptom, it is not a suitable sign by which to judge infection.
Spirochetes and
Their Movement
The bacterium that causes Lyme disease belongs to the spirochete family, and,
true to its name, it looks like a spiral. The spirochete’s shape allows it to be
very mobile. It moves with a drilling motion that allows it to travel through
denser tissues such as joint capsules, organs, and the blood-brain barrier
through a process called transmigration. Transmigration enables spirochetes
to invade tissue, triggering the host’s immune system. B. burgdorferi can
prompt the immune system to be in a continuous state of inflammation, which,
over time, can cause tissue damage and premature aging. The differences in
presentation for each patient with Lyme disease has to do with the person’s
immune system, the number of spirochetes present in the body, and other
individual factors, such as genetics.
The bacteria propel themselves with a wavelike motion using a tail, called
a flagellum. This uniquely built tail is hidden within the bacterium’s structure
instead of lagging behind, as in the case of a sperm cell. The presence of the
flagellum is significant because these bacteria rely on motility to evade the
host’s immune system—with their speed, spirochetes outrun the average
host’s immune cells. Without the flagellum, there would be no chronic Lyme
disease. Only through the spirochetes’ movement are they able to cause such a
havoc in the body through their ability to invade. Without that microbe’s tail,
our immune system and medications would more readily be able to eliminate
them. You can see the host’s immune response after a bite in those who
develop a bull’s-eye rash, called erythema migrans.
As I mentioned in the previous chapter, the infection moves from animal
to tick to human. It is a phenomenal event for a microbe to migrate from one
extreme environment to another, adapting to new surroundings in different
species, from tick to mammal. There are differing temperatures, pH levels,
and host immunity expression between the species. B. burgdorferi seems to
have a unique DNA sequence, with extra genes that help it adapt in these
differing environments.4 These are microbes without a country; they are
thrust into new surroundings and must adapt to a different environment
within a new body. If we can look past our fears and resentment of the
infection, we see that they are quite amazing resilient beings.
When microbes enter the tick’s stomach, they can live in the gut for a long
time between tick meals. When the tick gets ready to feed from the host,
specific proteins enable movement from the tick midgut to the tick salivary
gland—these are referred to as outer surface proteins (OSP).5 The longer the
tick is attached for meal, the more OSP is produced, which increases the number
of spirochetes in the tick gut and salivary glands, increasing the likelihood of
transmission.6 Antibodies to these specific proteins are used to confirm
exposure to Lyme disease—this is the basis for the Western blot test, which
I discuss in greater detail in chapter 4.
Can You Become

Immune to Lyme Disease?
Our adaptive immune system learns by coming into contact with infections,
responding with antibodies, then retaining memory of the infection in order
to clear it more efficiently the next time we encounter it. Unfortunately, the
immune system does not retain a memory of Lyme disease, as it does for other
infections. You can get Lyme disease repeatedly with each new tick bite.
D I V I N G D E E P E R I N T O C H R O N I C LY M E D I S E A S E 31
According to a 2014 article published in Infection and Immunity, if a patient
already treated for Lyme disease was exposed with new tick bites to an
identical strain, she could have protective immunity for up to six years. This
was only true if the exact strain was transmitted, however, and odds are not in
our favor given the biodiversity in the environment.
In 1998, a published case study in the Journal of Clinical Microbiology
detailed that skin biopsy culture of a bull’s-eye rash in the same individual at
two distinct times showed entirely different strains.7
The idea of reinfection with subsequent bites is usually not relayed to
patients in literature about prevention. The possibility of reexposure is also
not supported by insurance companies, which limit intravenous antibiotic
therapy to twenty-eight days only once in a patient’s lifetime. Typically, the
first twenty-eight days are covered; subsequent treatments, if needed, are an
out-of-pocket expense. Some states are creating laws to mandate coverage of
Lyme disease no matter the treatment time, but in many states proposed
legislation has been derailed by special interests in the insurance or medical
industries lobbying against the measures.
Game Changers: New Strains

with Atypical Presentation
A NEW STRAIN OF BACTERIA , Borrelia mayonii, was discovered in 2016 and
named after the Mayo Clinic, where it was first identified. This strain is found
primarily in ticks in Minnesota and Wisconsin, in the white-footed mouse, and in
the American red squirrel. 8 B. mayonii can cause nausea, vomiting, and a rash
with multiple rings appearing on the body at one time, not associated with
multiple tick bites. 9 I have seen this rash presentation in the clinic many times,
but because it’s not recognized by most doctors, it is usually diagnosed as an
allergic reaction and treated with steroids instead of antibiotics.
Another newly identified strain, Borrelia miyamotoi, is categorized as a
relapsing fever infection; though this type of infection is usually transmitted by
soft-bodied ticks, B. miyamotoi are carried by hard-bodied ticks.10 Infection with
this strain is associated with fever, joint pain, nausea, fatigue, and muscle aches.
There are also mild to severe symptoms of hemorrhage, ranging from the
appearance of broken blood vessels in skin to blood in the urine. B. miyamotoi
was first discovered in Japan and has since been confirmed in the United States.
The Transformative
Ability of Spirochetes
Spirochetes live in the body in four different forms, collected in a web of
biofilm, a highly organized goolike substance that provides protection and
nourishment for the microbes. These spirochete forms are spiral form, L-form,
cyst form, and blebs. Over time, as they live in the body, the spirochetes
transition from a spiral form by gradually straightening out, though they still
have visible kinks, which gives them the appearance of the letter L.
Commonly, spirochetes enter the body in the more mobile spiral form in
order to search out ideal environments to colonize. Once there, they morph
into different forms within the biofilm matrix they create. The spirochete will
then start to collapse in on itself, transitioning its outer covering from the
membrane of an animal cell to that of a plant cell. This is the common phe-
nomenon of the spirochete changing to different forms in the body: At all
times, there are spirochetes within an infected person in the spiral form, cyst
form, L-form, and blebs. The change from a long spiral with a malleable cell
membrane to a more formed cell wall in the shape of a ball is amazing to see.
This is a very dynamic microbe!
The spirochete colonies live in constant flux between these forms, each
form requiring a different antimicrobial medication for treatment. The
spirochetes will regrow, migrate, and build new colonies throughout the body.
This is why symptoms seem to migrate in the body, as the immune system
responds to activity in the different colonies with increased inflammation
creating discomfort.
Blebs is a term representing remnants of spirochetes with DNA proteins
that continue to trigger the immune system. Even without motility, they
create inflammation by their mere presence. This is another explanation for
the chronic nature of the infection, even after a long treatment time. Even if
the spirochetes are eliminated with antibiotics, small fragments can remain
in the body and trigger the immune system. It’s difficult for the body to
remove the debris when this disease migrates to places other infections do
not typically go, such as deep into organs, muscles, joint capsules, and brain
tissue. The reduced blood flow in certain areas of the body, such as the
central nervous system (brain and spinal cord) and joint capsules, make it
harder to heal.
D I V I N G D E E P E R I N T O C H R O N I C LY M E D I S E A S E
Biofilm Defense
The longer the spirochetes live in the body, the more deeply they colonize
tissue, living in any organ system. These colonies are dynamic collectives
within a living matrix called biofilm. When seen under a microscope, biofilm is
like a slime organized in elegant structures; created by several species of
bacteria, biofilms control population growth of the bacteria, sequester
nutrients, and provide protection against external assault. 11 It’s a natural
process of bacteria that predates humans. The most common biofilm, called
plaque, is in your mouth. Scientist Antonie van Leeuwenhoek discovered
biofilms in 1684, when he noticed that some bacteria were unable to survive
exposure to vinegar in the mouths of animals while those bacterial cells
encased in the slime matrix did survive.12
Made up of minerals, extracellular DNA, and polysaccharides, biofilm is
able to adapt to its environment and adjust to pH, host defense, and tempera-
ture, and to make intelligent modifications based on the competition of other
bacteria for nutrients. With biofilm responsible for 65 percent of all chronic
infections globally,13 it’s one of the major reasons Lyme disease is so difficult to
resolve. The bacteria within the biofilm would most likely be susceptible to
medications, but the medications cannot penetrate the biofilm effectively
enough to reduce the population of the pathogen, so it persists. This is a
different process from a microbe evolving to become antibiotic resistant on its
own in the environment.
Inhibiting biofilms is important when treating tick-borne disease. Bacteria
have an amazing ability to create natural barriers that block incoming assault,
as well as an ability to pump out invading toxins before they can cause harm.14
As the microbes settle in, they create a biofilm that makes B. burgdorferi a
thousand times more resistant to antimicrobial therapies. Eva Sapi, Ph.D., and
others have been studying the behavior of biofilms to understand how they
grow, what they are made up of, and how to improve clinical outcomes by
learning what substances penetrate it.15 Ongoing research is looking for both
pharmaceutical and natural medications to dismantle biofilm and inhibit
quorum sensing, bacteria’s method of communication to maintain healthy
populations in response to their environment. Herbs such as turmeric/
curcumin, garlic, oil of oregano, berberine, and green tea extract have been
shown to be viable options for their anti-biofilm and anti–quorum sensing
properties. Once these mechanisms are inhibited, the medications can more
effectively reach the Borrelia.
Sometimes the terms biofilm and bacterial antibiotic resistance are used
synonymously, but these are two different things. Antibiotic resistance is the
ability of the bacteria themselves to be resistant to a particular treatment. This
is also very different from the view held by many patients that they will
become resistant. It’s not the person who becomes resistant but the microbes.
This is a bigger issue than one person taking medications. The biggest
contributors to antibiotic resistance are the improper waste disposal of
antibiotics into the waterways and massive medicating of livestock with
antibiotics, which are then released in pastures onto the microbes in the soil.
With biofilms present, the bugs are susceptible to medications in many cases
but are protected by biofilm.
Signs of Acute Infection

A majority of my patients are chronic Lyme disease sufferers. However, each
one started with an acute manifestation that could possibly have been nipped
in the bud if they had been treated appropriately at the time of the bite.
Treating acute cases is rewarding because I can help people avoid months or
years of suffering.
The difficulties in getting treatment for acute bites are discussed through-
out the book. When treatment is given, it’s commonly one capsule of doxycy-
cline, which is not enough to kill the spirochetes. One capsule of doxycycline
has been proven ineffective but remains the treatment recommended by the
Centers for Disease Control.16 No other routine bacterial infections are treated
with a single dose of an antibiotic, yet this is deemed adequate for a complex
migrating microbe such as a spirochete. Other infections transmitted along
with Lyme disease make the scenario more complicated, warranting treat-
ment for at least thirty days with a new bite. With an acute Lyme disease
infection, patients can experience symptoms within twenty-four hours to
fourteen days. There may also be no major symptoms to raise concern, making
it more likely to become a chronic infection.
The rash can exhibit the classic bull’s-eye that is a few inches in diameter,
or it can present as multiple rings. It may also be one giant ring spanning the
length of the leg or across the torso. Many patients report that they initially
did not seek medical care for their tick bites because no ring rash formed.
Slowly, over the course of a couple of months, they started to notice they were
more fatigued, with body aches, swollen joints, neck pain, headaches, vertigo,
rashes, fevers, and chills.
One of the most dramatic symptoms that can accompany Lyme disease is
Bell’s palsy, though I have seen very few cases of acute Bell’s palsy in my
years of practice. This condition is caused by inflammation of the seventh
cranial nerve, which leads to weakness and
a loss of tone on one side of the face. This
Lyme disease can impair a person’s ability to speak clearly
is consistently and may create visual impairment with a
inconsistent. drooping eyelid. This symptom can resolve
with treatment, returning the face to
normal symmetry. People are frequently diagnosed with Bell’s palsy due to
viral infection, so they are not given antibiotics. When Bell’s palsy continues
for a long period of time, the face may not regain true symmetry; however,
there can be improvement with treatment, even in later-stage cases.
When Acute Lyme Disease

Becomes Chronic
Chronic Lyme disease is known as The Great Imitator. It can look like many
autoimmune diseases, including rheumatoid arthritis, lupus, Sjögren’s
syndrome, or mixed connective tissue disease. It’s also commonly misdiag-
nosed as a neurological disease, such as Parkinson’s disease or multiple
sclerosis. Arthritic and/or neurological diseases may also exist in the body
along with Lyme disease and can create enough stress on the immune system
to set other disease processes in motion.
Lyme disease has different stages of severity, referred to as early dissemi-
nated infection and late disseminated infection. Early disseminated infection
can last weeks to months if the acute infection is not treated. Late dissemi-
nated infection can last months or years, with neurological symptoms
progressing over time. Symptoms are commonly found in multiple areas of a
patient’s body, with complaints of musculoskeletal pain, neurological symp-
toms, cardiorespiratory symptoms, endocrine imbalance, skin lesions, and
gastrointestinal problems. The symptoms come and go, migrating through the
body with no rhyme or reason.
Spirochetes love areas of the body that have low blood flow but are high in
fat and sugar, such as connective tissue, joint capsules, and nerve tissue such
as the brain, which is mostly fat. These microbes can live anywhere, even
landing in scar tissue because of the reduced circulation in those areas. Lyme
disease is consistently inconsistent. This you can rely on. It’s just plain
confusing for patients and doctors who are used to the presentation of
infections being more reliable. The location of the tick bite and the specific
infections introduced into the system have a lot to do with this variability.
The first thing I ask patients at the beginning of a visit is when they last
felt well. From there, I ask to hear the patient’s story before moving to my
office and reviewing their symptoms from head to toe. I see in people’s eyes a
look of relief because they had been thinking all this time that they were
experiencing an unexplained phenomenon. They may have brought their
symptoms up to doctors in the past, only to be met with responses that caused
them embarrassment as they were told their feelings were irrelevant and they
should seek counseling. One example of a commonly dismissed symptom,
thought of as a sign of mental imbalance, is a sensation like bugs creeping on
the skin. Patients are always relieved to know I saw several people in the office
before them that day with the same symptom. I experienced it myself, and this
was the symptom that finally got my attention and prompted me to look
deeper into my own Lyme disease.
Can I Transmit Lyme Disease

to My Partner?
At some point, a patient will ask me about the possibility of transferring Lyme
disease to a partner through sexual relations. The topic of transmission by
human-to-human contact is an important one, and there is a great deal of
misinformation out there. I have counseled many patients who already feel
isolated and misunderstood when they tell others they have Lyme disease, and
they are now abstaining from sexual intimacy or even kissing for fear of
passing the disease to another person. This is a burden people carry in addition
to their diagnosis.
Transmission through saliva has not been proven; however, some Internet
research and the varying opinions of medical professionals can leave a
traumatizing impression. It is highly unlikely that Borrelia spirochetes survive
in saliva given the oxygen-rich microenvironment of the mouth. Some
microbes can persist either inside or outside the body; however, B. burgdorferi
is very sensitive to its environment, and the oral cavity is not a viable place for
it to thrive. If it were easy to catch Lyme disease from a kiss, it would be a
global epidemic rather than one dependent on geographical areas with
environments ideal for ticks.
There is a distinct possibility, however, that Lyme disease can be sexually
transmitted. In a 2015 study of twelve couples, B. burgdorferi was cultured out
of vaginal secretions and semen, and the couples had identical strains in their
samples.17 This was an important finding, prompting deeper research to
understand how Lyme disease can be transmitted sexually. Gregory Bach,
D.O., had observed in 2001 that monogamous couples with one partner who
had confirmed Lyme disease typically had more antibiotic failure.18 Of course,
many people carrying Lyme disease do not know it and may pass it through
intimate acts. It’s also important to mention that most partners have similar
exposure to ticks because they live on the same property and engage in many
of the same activities.
When fear that Lyme disease could be spread from person to person first
made its way through the Lyme disease community, I was asked about it
almost daily. Many couples came in crying, and women worried they had
infected their husbands. This possibility has an adverse effect emotionally and
is difficult to manage on top of the other stressors within relationships when
chronic Lyme disease is involved. Often, women seem to carry this burden
emotionally, as if they are to blame. I’ve witnessed some unpleasant interac-
tions between couples, with one partner blaming the other for giving him or
her Lyme disease. Until there is more research on this topic and we under-
stand the incidence of transmission more clearly, I encourage people to step
away from the language of blame within relationships.
Based on the preliminary data, it would be wise to use barrier methods
during sex while undergoing treatment for tick-borne infection, not only to
protect your partner but because it could help resolve the infection more
efficiently by avoiding passing it back and forth. More research is needed to
understand the sexual transmission of Lyme disease. In the meantime, you
should fully enjoy intimacy but take precautions.
Mother-to-Child Transmission
I have treated many women with Lyme disease and other tick-borne infections
who report having a difficult time getting pregnant or having had more than
one miscarriage. Pregnant patients with a history of chronic Lyme disease or
who are infected during pregnancy may have positive cord blood tests in their
newborns. This means transmission occurred either in utero or during the
birth process. Cord blood testing involves taking a sample directly from the
cord before it is cut. For the purposes of identifying the presence of infection,
all tests that would commonly be run on an adult can be run on a newborn
through their cord blood, where mother and child’s blood intermingle through
the birth process. I would recommend doing a Western blot to check for
contamination of the cord blood (mother’s and infant’s blood commingled) as
well as a culture to check for the growth of spirochetes within the infant’s
blood. Both would be helpful in eliminating questions about transmission; the
infant’s antibodies are not developed enough at the time of birth to make the
information of the Western blot reliable as a primary source.
If the result is positive, Lyme disease was transmitted, and both mother
and baby should be treated by a Lyme-literate doctor. I have had several
pregnant patients with active Lyme disease—who either had it before they
conceived or who contracted it during pregnancy—give birth to healthy
children. It’s important, if mom is suspected or confirmed as having Lyme
disease, that she be treated.
The protocols I follow for treating during pregnancy, infancy, and up to
adolescence are based on those created by Charles Ray Jones, M.D., one of the
foremost experts in pediatric Lyme disease in the world. I have had the
privilege of learning from him by cotreating patients and seeing him speak on
several occasions. I am so grateful for his work and contributions to the Lyme
community. Treating during pregnancy is delicate, and only antibiotic
medications safe in pregnancy are used.
Peer-reviewed journals feature articles referencing the increased inci-
dence of cardiac and other physical malformation in babies whose mothers
have been exposed to Lyme disease.19 However, many articles state the
opposite, making it difficult to know how to proceed. There are several
articles on the impact of Babesia species in pregnancy, with most case studies
involving the treatment of the pregnant patient and screening of the newborn
via blood smears. Mother and baby were reported healthy at follow-up a few
months after delivery. Most of the studies of vertical transmission—transmis-
sion from mother to child instead of from a tick—have been conducted with
animals such as voles and mice and show a high rate of transmission. 20
Many mothers with positive titers (a measure of the presence and number
of antibodies in the blood) for Lyme and other tick-borne diseases report
having children with poor attention, difficulty learning, sensory integration
issues, and increased incidence of allergies. Clinically, these are common
reports on a pediatric patient’s health history from their parents, who thought
they just had a colicky baby. Mothers with infected children usually wonder if
they gave the disease to their children during pregnancy. It’s deeply painful to
find out you may have infected your own child with Lyme disease.
I was infected in 2009, during my third trimester of pregnancy. At the
time, I was very ill, with a high fever and intense body pain for over a week. I
thought it was the H1N1 viral infection prevalent that year. After my son was
born, my recovery was really difficult. I was in pain daily, could not lose the
baby weight, was emotionally out of balance, felt dizzy, had night sweats, and
suffered from chronic headaches and brain fog. At the time, I had a two-year-
old daughter and a newborn and was getting a new clinic off the ground. I was
exhausted, but it was easy to blame my symptoms on circumstances. This line
of thinking delayed my treatment. Even a Lyme-literate doctor can downplay
symptoms, despite her job discussing Lyme disease with patients every day.
I tell moms to put a time limit on their self-blame or grief. It’s important
that they be allowed to process their emotions but not to punish themselves.
I see mothers carry shame and guilt for years over feeling they are the cause
of their child’s infection. Many manage their fear by spending every spare
moment researching a cure for the child, to the point that they are not engaged
in family relationships. Life becomes all about the illness. It’s easy to under-
stand the motivation behind it, but a hyperfocus on any one thing is not
healthy. Even when the child starts to recover, a mom or dad may not be able
to see it because the search has been a part of their lives for so long.
Age-Specific Challenges
of Lyme Disease
Children have a unique experience with Lyme disease. I routinely treat infants
and toddlers who have minimal verbal skills after a tick bite or positive test for
Lyme disease. The most common age groups at risk for tick bites are those
aged two to fifteen and thirty to fifty-five. Children ages five to ten years are
especially at risk because they are low to the ground, favor play structures
near the forest line or in the shade, and have thinner skin than toddlers.
Depending on the age of the child and the level of awareness they have about
ticks, they may also be more likely to pull a tick off without telling a parent or
teacher. This is why it’s important to start tick awareness with children as
early as possible, so they will know to tell you if they see one on their body.
It’s easy if a parent brings the child in after a Lyme disease–positive tick
was pulled from the child and tested through a lab. This means we have pretty
conclusive evidence of exposure. I’m not willing to take the risk of waiting to
see whether there are any ill effects. Thankfully, tick testing usually encom-
passes not just Lyme disease but a panel of tick-borne infections. This can be
really helpful in choosing the right medication from the get-go.
If your child is bitten but you never find a tick, the child may get a fever,
joint pain, and a red ring around the bite site. However, he may just slowly
over time have a change in personality with slight complaints of stomach pain,
leg pain, and headache. Many parents, with loving intention, question whether
their child is just trying to get attention until the symptoms are undeniable.
They then take their child to the pediatrician, who is not comfortable testing
or treating if there is no history of known tick bite.
Parents know there is something wrong with their
child, but most end up with a diagnosis of behavioral
As children
problems, attention deficit disorder, or an auto- mature into
immune disorder requiring intense medication teenagers,
regimens that are likely not needed.
Lyme disease
As children mature into teenagers, Lyme disease
symptoms can amplify due to hormone changes in
symptoms can
both genders and the onset of menses in girls. Where amplify due
there were just random complaints of headaches, to hormone
stomachaches, and difficulty concentrating, there may
changes in
now be debilitating fatigue and a constellation of
symptoms listed above. The immune system, together
both genders
with the fact that this is a time of growth and develop- and the onset of
ment, complicates the symptoms. Over the years, I menses in girls.
have seen many cases of teenagers well past the time
they would be expected to show signs of pubertal changes who have not begun
to develop. A teen of fifteen may maintain the body of an eleven-year-old. Once
the infection is identified and treated, they start maturing almost overnight.
Teenagers and college kids add another layer of complexity by having an
illness smack dab in the middle of teen rebellion years and at a time when so
many expectations are placed on them. Many will reject their medications,
make poor food choices, and resent any attempt to provide medical care.
Others will continue to participate in high-impact sports and try to keep the
same course load out of a fear that they will not be successful enough. This is
not true of every teenager, but it does come up with many.
The most difficult situation arises when they are not able to attend school
and fall behind. Some school administrations are very supportive and empa-
thetic, but I have unfortunately dealt with many schools that penalized
families for truancy because the school fails to accept Lyme disease as a
serious illness. Even for teens who enjoy being with their families, being at
home and losing social connections at this stage in their lives can be very
stressful. The good news is that most kids who require homeschooling return
to school and usually catch up quickly.
I treat several adolescent patients who are extremely compliant but also kids
who want nothing to do with a diagnosis of Lyme disease. Many believe their
parents are just paranoid. Avoiding treatment just delays recovery. Most young
people who did not take treatment seriously finally decide to treat when they are
over the age of twenty and they step into maturity managing their own health.
Often, their resentment and rejection of treatment is rooted in fear. If they have
been raised with a parent or sibling who has been ill most of their lives, it’s
frightening to be the one to face the disease, which can cause them to flee from
the situation. Most of the time, though, kids recover from tick-borne disease
more easily than adults; this is not to say it is easy, by any means—just easier.
A Symptom Profile of
Chronic Lyme Disease
The symptoms presented here are those I see on a daily basis. Many Lyme
disease symptoms overlap with those of coinfections, so finding the right
treatment sometimes requires trial and error. Symptoms noted below are
based on the most common presentations, but the list is not exhaustive.
H E A D, E Y E S , E A R S , N O S E , A N D T H R OAT
Most Lyme patients complain of headaches, which can be a daily occurrence.
Many just get used to them. All types of headaches can manifest; typically,
they are centered behind or above the eyes or radiate from the back of the
neck, over the top of the head. They also vary in intensity, from a dull ache to
an intense migraine that limits activity. Frequency can vary between constant
daily pain or flare-ups every few weeks. The most common presentation is a
constant low-level headache that gets in the way of concentration; this needs
to be factored in when kids are labeled as having focus and attention issues. If
a child has had Lyme disease from a young age, he may have learned to
compensate and live with the pain.
Many patients also experience a sensation of being lightheaded, with or
without a headache; sometimes, the lightheadedness is accompanied by more
debilitating forms of vertigo such as dizziness upon standing or a continuous
sensation of instability that limits daily function. This can be accompanied by
brain fog or a feeling of being mentally/emotionally dissociated. The vertigo
can be related to inner ear inflammation caused by the presence of spirochetes
in the central nervous system, or it may be related to a cardiovascular abnor-
mality, with blood return to the brain. Prescription medications, homeopath-
ics taken at the time of vertigo episodes, or acupressure wristbands (brand
name Sea-Band) can reduce the severity. Sea-Band is an affordable drug-free
remedy and can be purchased at your local pharmacy.
Changes in vision are typical. The most common symptoms reported are
light sensitivity, spontaneous blurred vision, blind spots, and abnormal
phenomena, such as orbs, in the field of vision. Floaters can be dark spots,
sparkles, or tracers; just about everyone with chronic Lyme disease has
floaters in their field of vision. These may also look like squiggly lines. Patients
report floaters that look like a spirochete itself moving across their field of
vision; however, this is not actually a spirochete, since they are too small to see
with the naked eye.
Over the years, I have also seen many patients become unable to drive
because they get disoriented and visually overstimulated while in the car.
Even riding as a passenger can present problems, and some patients require
time to reorient themselves once they arrive at the clinic before the visit
starts. Many patients wear blackout masks to prevent sensory overload.
Several have gone months or years without being able to drive on their own.
Light sensitivity requires many patients to wear sunglasses both outdoors
and indoors. I have dimmers on the lights in my office so I can adjust lighting
for patient comfort. An eye exam often shows that patients have dilated pupils
due to adrenal fatigue from the stress of prolonged illness, which can also
create more sensitivity to light. Uveitis, inflammation of the middle layer of
the eye, is common with tick-borne disease, most commonly with Borrelia,
Bartonella, and Rickettsia species with a genetic marker of HLA-B27.21 Many
patients also have uncomfortable sensations of burning and dry eye. Most
require an eye specialist as they move through treatment.
Tinnitus (ringing in the ears) is the most common change in hearing.
Many different sounds are reported—such as clicking, popping, hissing, and
ringing—which reduce the ability of the patient to hear. Tinnitus can be
isolated in one ear or may occur in both. In most cases, it is the presence of a
tone that causes varying levels of annoyance. Many patients are erroneously
diagnosed with Ménière’s disease, which is vertigo with tinnitus and hearing
loss. Some patients experience pain or itching in the ear canal.
A handful of patients require sound-cancelling headphones to combat a
debilitating symptom called hyperacusis, a hypersensitivity to everyday
sounds. This condition can be downright painful and may require significant
micromanagement of daily life to minimize the negative sensation of sound.
If a patient reports hyperacusis, I always recommend counseling to help them
develop coping mechanisms and support the trauma associated with phono-
phobia (fear of sound) and isolation from social situations due to the discom-
fort created by even soft sounds. Individuals with long-term hyperacusis
develop depression and anxiety due to avoidance of sound triggers.
Retraining the nervous system response using neural biofeedback,
hypnotherapy, or pink noise therapy can be a valuable way of managing stress.
Like the white noise commonly used in sleep sound machines or fans, pink
noise is reduced in intensity and features softer tones. Exposure to this noise
can decrease the awareness of the tinnitus or expose those with hyperacusis
to bearable sounds so they gradually become able to tolerate more noise.
Sinus headaches are very common, together with an increased incidence of
persistent sinus infections, which may have been in the body prior to contracting
Lyme disease but are more active with a weakened immune system. Nasal swab
culture testing can identify the strain of infection as well as the presence of
antibiotic-resistant infections in the sinus cavity. The treatment chosen is based
on the susceptibility of the strain of sinus infection to certain medications.
Recurrent sore throats, with or without enlarged tonsils, are very common.
This can be due to chronic strep and Epstein-Barr infections related to mononu-
cleosis, which can become more active once Lyme disease is in the body. These
are opportunistic infections that emerge in a host with a weakened immune
system. They can cause enlarged lymph nodes and pain in the head and neck, as
the body’s immune system tries to clear the infection. Upon medical exam, most
patients have enlarged tonsils and report pain as well as changes in voice quality.
NERVOUS SYSTEM
Neurological symptoms can range from subtle annoyances to debilitating
experiences. They will arise depending on the location of the infection and
how long it has been present in the body. Patients sometimes come to me
having been diagnosed by a neurologist with amyotrophic lateral sclerosis
(ALS, also known as Lou Gehrig’s disease), Parkinson’s disease, or multiple
sclerosis. Yet over time the disease does not show the typical progression and
the medications prescribed do not have the expected impact. The long-term
presence of infections living in the nervous system can be a catalyst for the
aforementioned diseases, and repeated cycles of inflammation caused by
long-term infections can destroy neurons.
Research reported in the Journal of Neuroinflammation in 2013 found that
Lyme disease creates inflammation markers that specifically target peripheral
nerve cells and the regenerative components of the nervous system, called the
glial cells.22 It’s an attack by your own immune system on the pathogen, but it
damages tissues as a side effect. The myelin sheaths covering and protecting
nerves are altered, which leads to improper transmission of information and,
ultimately, pain or loss of sensation. This does not happen overnight but over
the course of years, after several bites from ticks and the resulting long-
running attack on tissues by the immune system.
Neurological symptoms run the gamut, representing decreased or
increased activity in the neurological system. Decrease of function includes
loss of motor skills, slowed processing of information, depressed mood, and
loss of sensation in different areas of the body. This potentially leads to altered
gait, weakness, muscle wasting, difficulty swallowing, numbness in multiple
areas of the body, and/or altered speech patterns, including slowed speech,
slurred speech, stuttering, and difficulty with word recall.
An overactive neurological system can create muscle twitches, tremors,
increased pain, itching of the skin, burning sensations, anxiety, seizures, tics,
rapid speech, and hyperactivity. Other symptoms seen in very advanced
stages of infection include an inability to write clearly and even a complete
change of personality. Many patients present to the clinic with their only
symptom being slowed speech, or dysphonia. This is a difficult symptom to
reverse, and each patient I have personally seen with this symptom has tested
positive for Lyme disease.
M U S C U LO S K E L E TA L S YS T E M
The musculoskeletal system includes joints, muscles, tendons, ligaments,
fascia, and bones. Pain, swelling, weakness, increased joint instability, and
reduced function due to pain are common. Symptoms may migrate throughout
the day, with a patient feeling knee pain in the morning that radiates to the
hips in the afternoon, moves from side to side, and ends the day in the neck.
Commonly, joint swelling comes and goes with no pattern. Symptoms can be
isolated in one spot, such as a knee, hip, hand, neck, spine, or foot, or may be
felt in multiple places at one time.
Most patients have been diagnosed with fibromyalgia before they come to
the clinic; this is a formal diagnosis of fatigue and widespread pain in the
muscles. This diagnosis describes symptoms but not why the muscles hurt.
The body is intelligent, having evolved to survive on this planet, and there is a
reason the muscles are sore. Is it always infection? No. Does infection need to
be evaluated as a cause? Yes.
Pain typically escalates with initial treatment for Lyme disease, and this is
the number one reason that treatment fails. Patients often elect to stop medica-
tions because the pain is too intense; however, treatment can be modified to
reduce the intensity. Most patients have been diagnosed with rheumatoid
arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, Sjögren’s
syndrome, sarcoidosis, mixed connective tissue disease, or another condition.
Patient labs can show elevated rheumatoid factor, antinuclear antibodies,
sedimentation rate, and C-reactive protein in reaction to the presence of
spirochetes in their tissues. More often than not, however, just one marker is
elevated, with no other blood results confirming autoimmune disease.
A study published in 2017 in the journal Arthritis and Rheumatology showed
that B. burgdorferi–infected joint capsules had an increase of proteins meant to
initiate antibacterial action. This protein increase also happens with synovial
fluid (fluid in a certain type of joint), which shows bactericidal activity in
situations of septic arthritis when there is staph infection in the joint. Chronic
Lyme disease increases proteins associated with chronic inflammation, which
Autonomic Dysfunction
THE AUTONOMIC NERVOUS SYSTEM (ANS), part of the peripheral nervous
system, regulates blood pressure, urinary function, stress response, sweating,
and digestion. The two primary areas governing function are the sympathetic
and parasympathetic nervous systems. The sympathetic nervous system
controls the fight-or-flight response, while the parasympathetic controls the
rest-digest response.
Autonomic dysfunction, or dysautonomia, is the inability of the ANS to
behave as it typically would in coping with moment-to-moment life stress to
maintain balance. This commonly happens with chronic conditions such as
Lyme disease, autoimmune disease, and diabetes.
Lyme disease microbes can migrate and have an affinity for nerves, which
causes abnormal function. The nerves of the ANS are no exception. Patients
who display autonomic dysfunction are more likely to be diagnosed as having
conversion disorder or psychosomatic illness. This is because Lyme disease is
very difficult to diagnose and may seem purely a manifestation of poor coping
skills. Autonomic imbalance can also lead to low blood pressure, referred to as
orthostatic hypotension, and postural orthostatic tachycardia, characterized by
dizziness on standing. Both these conditions represent the body’s inability to
maintain proper heart rate and blood pressure when moving from a sitting to a
standing position. The constriction or dilation of blood vessels is mediated by
the autonomic nervous system, and it makes adjustments as we move, moment
to moment. Fainting can be the consequence of this imbalance, and it can
happen at inconvenient times in public places. Improper ANS response can also
cause bladder control issues, slowed gastric emptying, sweating, poor exercise
tolerance, and shortness of breath.
Many patients with these symptoms are labeled as mental instable, as the
symptoms are viewed as purely anxiety driven. There is an anxiety component,
certainly, as patients who have involuntary physical symptoms may be afraid to
go out in public. Most require a gentle environment and micromanagement of
stressors so as not to trigger fainting. Over the years, I’ve had several patients
who have lost consciousness in my office, even with my best efforts to maintain
a peaceful situation. Just getting through an office visit in which they are
reporting symptoms can be too much for some.
Patients respond well to intravenous electrolyte hydration, increased
electrolytes in the diet, and adrenal support. Many require conventional medica-
tions to regulate blood pressure, often taking medication to raise their pressure.
Studies have shown that meditation and yoga can be helpful in improving
autonomic function in patients with advanced neurological impairment. 23
is inflammation without resolution. This causes poor wound healing or leads to
tissue with reduced integrity.24 It’s especially complicated for patients with an
HLA-B27 marker present because they are more likely to develop persistent
autoimmune reactions that impact the eyes and musculoskeletal system. If this
marker is present in a patient, it is probable that her most persisting symptoms
will be joint pain and visual abnormalities.
Most of the conventional treatments for autoimmune diseases are geared
toward symptom management, typically chemotherapeutic medications,
steroids, and anti-inflammatories. There are times when steroids and anti-
inflammatories are needed to care for severe conditions, but these drugs carry
a high risk of side effects. If long-term use of steroids to manage the symptoms
of an autoimmune disease is being recommended to you, I would urge you to
get a second opinion from a naturopathic practitioner or someone trained in
complementary medicine. If natural medicine offers no different answers, you
can always return to the path of palliation with steroids, which may ultimately
be the right answer for you. Most patients are nervous of taking medications,
including the ones I recommend, but when push comes to shove, most patients
opt to take a medication that will help resolve their symptoms.
E N D O C R I N E S YS T E M
No matter the infection—whether it is bacterial, viral, parasitic, or fungal—the
endocrine system is affected. The system is usually thrown out of balance, either
overproducing or underproducing hormones. The endocrine system manages
immune function in the body and includes glands and their cross-communication
with other organ systems. The glands most commonly evaluated are ovaries/
testes, adrenals, pancreas, thymus, thyroid, parathyroid, pituitary, and pineal.
The function of almost all the glands can be tested via either blood work or saliva.
In evaluating the status of the hormone system, I’m interested in body
temperature, blood pressure, female hormone cycles, libido in both genders,
weight status, cravings, and energy level. Typically, patients present with low
body temperature, in the range of 97.7°F (36.5°C) or below. This most commonly
happens because of low thyroid function. Many patients have a low-functioning
thyroid and require hormone replacement. Common complaints with low-
functioning thyroid (hypothyroidism) are an inability to lose weight, low libido,
debilitating fatigue, dry skin, sluggish bowels, sugar/salt craving, and low blood
pressure. Hypertension can also be an issue with hypothyroidism.
A majority of my patient population are women ages twenty to sixty years.
This is consistent with the average patient population in a given general
practitioner’s office, as women seem to be more open to seeking medical
attention and more in tune with changes in their bodies, especially
Insult to Injury
LYME DISEASE SYMPTOMS COMMONLY EMERGE after a trauma to the body in
the form of physical injury or a major life stressor. Old injuries can start to act up
again when a patient has Lyme disease. For example, a patient who had surgical
repair to a knee or shoulder years earlier may begin to experience pain and
stiffness again. Spirochetes have a habit of colonizing in scar tissue because
these areas tend to be cooler and more prone to inflammation, having a weaker
tissue matrix due to previous injury and reduced blood flow. There have been
many cases over the years—with injuries as simple as a collision on the soccer
field or as serious as a car accident—where the person does not recover in a
typical time frame because of dormant Lyme disease. The patient might develop
migrating joint pain, headaches, fatigue, and neurological symptoms, though
there were none before the injury.
If you have an injury that is not healing in a proper time frame, consider that
infection may be the cause. If you live in an area endemic for Lyme disease or
have visited one on vacation, you may have been exposed to tick-borne infec-
tion even if you don’t remember a bite. For the most accurate result, ask to have
a Lyme Western blot test run (see chapter 4 for more on testing). Speak with a
Lyme-literate medical professional to ensure that you are treated properly and
in a timely way.
irregularities in their periods. Women with chronic Lyme disease almost

always have changes in menstruation, including periods that are too heavy,
too light, too short, too long, absent, or accompanied by intense pain. They
may also experience early menopause, infertility, repeated miscarriages, and
an intensification of tick-borne symptoms before their periods. The beauty of
this sign of imbalance is that normal function usually resumes as they recover,
indicating a return to health.
Many women have estrogen dominance with low progesterone due to
prolonged stress and genetic predisposition. Estrogen makes tissue grow, and
progesterone helps tissue develop properly, particularly in the lining of the
uterus. A hormone imbalance with estrogen dominance leads to endometrio-
sis, fibroid development, and other cycle irregularities, such as periods that
are too heavy and too lengthy. Cycles that in healthy adult females average
twenty-eight to forty days occur every fourteen to twenty-one days in Lyme
patients. This leads to excessive blood loss, causing iron deficiency and fatigue.
Such irregularities are usually caused by altered communication between the
brain and the uterus as well as between the adrenals and ovaries. This
miscommunication is due to the long-term stress on
the system that chronic Lyme disease causes.
Men may experience low libido and low testoster-
Debilitating
one levels at younger ages than would normally be fatigue is the
seen. Just as women pass through menopause, men most common
go through andropause, a natural, age-related
hormone-
decrease of testosterone. However, I am seeing men
in their twenties who have hormone levels like those
related symptom
of men in their seventies. Men can also become of Lyme disease,
overly estrogenic as part of the stress on their bodies. other than pain.
Low testosterone in both genders can lead to reduced
muscle mass, low energy, poor wound healing, and premature aging.
Debilitating fatigue is the most common hormone-related symptom of Lyme
disease, other than pain. Fatigue creates a vicious cycle of stress because patients
want to maintain their usual pace of life. This leads to anxiety and depression as
they worry about not measuring up. High levels of fatigue can affect a person’s
ability to be an active parent, maintain a job, and care for a home and relation-
ships. Most fear not being the person they were before they got sick and becom-
ing a burden to their loved ones. Debilitating fatigue is typically due to adrenal
fatigue; in this condition, the glands sitting atop the kidneys are depleted by
prolonged stress, disrupting the hormones that support proper sleep cycles,
insulin sensitivity, energy levels, and cellular repair. For all my patients, I advise
supporting the adrenals with herbal compounds as a standard of care. Adrenal
glands can be tested for their level of function, which I will discuss in chapter 4.
Typical symptoms of adrenal fatigue are energy decline after lunch together with
sugar cravings, caffeine use, weight gain around the middle, and sleep disruption.
SKIN, HAIR, AND NAILS

Skin can show signs of poor wound healing, stretch marks, brittle nails, fungal
overgrowth on skin/nailbeds, hives, tinea versicolor (a fungal infection of the
skin), easy bruising, fast-growing spider veins, Raynaud’s syndrome, creeping
sensations on the skin, burning sensations, intense sensitivity, and chronic
itching. Stretch marks are most frequently seen with Bartonella infections.
Rashes resembling those found with broken blood vessels on the skin with dotted
appearance happen more frequently with Babesiosis. There can also be flares of
conditions that a patient had before contracting Lyme disease, such as seborrheic
dermatitis and psoriasis. Typically, issues with skin, nails, and hair indicate
issues with the hormone system. Almost every Lyme disease patient complains of
problems in this area, with hair loss in women being the most frequent.
I have seen many symptoms involving hair, skin, and nails improve in
patients when treated for Lyme disease using natural anti-inflammatories and
addressing food sensitivities. Cycles of relapse and remission of tinea versi-
color, a fungal infection of the skin that causes pigment loss, may also occur.
For some, treatment of tick-borne disease results in a return of pigmentation
to the skin. With patients who relapse, pigmentation diminishes again. This is
another sign of the immune compromise that comes with a larger infection.
Tinea versicolor is not contagious but will be more active during times of
reduced internal vitality.
The three cardinal skin manifestations of Lyme disease are bull’s-eye rash
(erythema chronicum migrans), a painless bluish-red nodule or plaque (borrelial
lymphocytoma), and red or bluish lesions progressing to atrophy of the skin,
known as ACA (acrodermatitis chronica atrophicans).25 Erythema migrans, the
common bull’s-eye rash, may appear days or weeks after tick attachment. It has
become the key symptom used to determine if the bite was infectious, which can
be misleading. Far too many people acquire Lyme disease without having
developed a red ring at the site, so it should not be used as a confirmation.
Borrelial lymphocytoma, which I have not seen in clinical practice, is one of the
less common presentations. This symptom is more common with strains in
Europe and looks like a red molelike swelling on the ear lobe or around the areola
of the breast. With acrodermatitis chronica atrophicans, the skin can become
thinner and darker in tone, with the skin looking aged beyond its years.
Lyme disease can trigger inflammatory responses in the body, altering the
collagen matrix.26 This creates weakness, with increased instability in
tendons, ligaments, and skin. It alters the connective tissue within organ
systems such as the heart and increases inflammation in the digestive tract,
leading to inflammatory bowel disorders. Hyaluronic acid, a protein found in
skin, joints, and ligaments, is impacted by the presence of spirochetes. This
protein holds water in the tissues, allowing them to maintain lubrication and
proper form. If the structure of these tissues is altered, they will dry out,
leading to premature aging.
Calcifications and hypoxia (a deficiency in the amount of oxygen) also occur
in joints and tendons, causing pain like that of carpal tunnel syndrome. Many
patients present to the clinic with a history of surgery to correct carpal tunnel
before they realized they may also have Lyme disease. They also experience
more popping, cracking, and increased hypermobility of the joints. Hyaluronic
acid can be supplemented by taking collagen type I/III and/or bone broth.
C A R D I OVA S C U L A R A N D R E S P I R ATO RY S YS T E M S
Most patients in my office see a cardiologist before investigating Lyme disease.
Typically, they are given a clean bill of health because the heart is normal
according to all diagnostic testing, which includes electrocardiogram (EKG),
echocardiogram, and stress tests. However, patients report heart palpitations,
flutters, chest pain, rib pain, and low or high blood pressure. Shortness of
breath can be a key symptom with Babesia infections, as are autonomic
dysfunction and past history of asthma/allergies. Symptom flares in the
cardiopulmonary system are the most common reason patients visit an
emergency room—and for good reason, because heart attacks can be very
subtle. It’s always better to go to the emergency room than to stay home and
risk an emergency. Typically, after being examined and tested at the emer-
gency room, patients are discharged with antianxiety medications.
In more severe cases of Lyme disease, nerve conduction problems, called
bundle branch blocks, can develop in the heart. This condition creates difficulty
with proper heart rhythm and the contraction cycles responsible for adequately
pumping blood through the heart. I have treated several patients over the years
who have tick-borne disease with pericarditis, an infection and inflammation
that develops in the fluid between the pericardium and the heart. This can
constrict the heart because it reduces the space in which the heart can expand
and contract with each beat. Fever may or may not accompany this infection, but
pain is intense. Due to its critical nature, pericarditis requires medical manage-
ment by a cardiovascular specialist who can monitor and medicate the condition
as warranted. Patients who have issues with pericarditis also commonly have a
confirmed diagnosis of Rocky Mountain spotted fever.
D I G E S T I V E S YS T E M
Digestive issues are common patient complaints during their first office visit.
These can include irritable bowel syndrome with alternating cycles of diarrhea
and constipation, a recent onset of food allergy or intolerance, nausea, and/or
changes in appetite leading to weight loss. Abdominal pain can vary from
patient to patient, with some doubled over while others experience milder
symptoms associated with gas and bloating. In children, abdominal pain is one
of the primary symptoms of Lyme disease. Some patients have noted chronic
burping as a symptom, but it’s rare. Another interesting symptom mentioned
over the years is the sensation of bugs crawling in the digestive tract.
Whatever the digestive complaint, the symptom requires support because
the patient will need to tolerate oral medication. Whether natural or antibi-
otic, medications usually cause changes in digestive patterns. Patients with
abdominal pain as part of a neurological component can be difficult to keep on
medication because they may have what is known as a Herxheimer reaction
(see chapter 6 for more on this response), which amplifies their pain and often
leads them to discontinue the treatment.
Digestive distress related to Lyme disease is a combination of two issues:
(1) increased inflammation in the gut, resulting in poor absorption and
irritable bowel, and (2) increased sensitivity to foods.
Recently, I am often asked about tick-borne disease causing a red meat
allergy. This is related to alpha-gal allergy, an anaphylactic reaction to a
specific carbohydrate molecule found in the cells of animals that humans
consume for food, such as cattle, pigs, and sheep. This allergic reaction can
develop after the bite of a Lone Star tick, which, in the United States, most
commonly carries ehrlichiosis or Rocky Mountain spotted fever. Other Ixodes
species are implicated with the allergy in Australia and Europe. The alpha-gal
allergic response usually involves itchy hives and gastrointestinal symptoms
such as nausea two to six hours after ingesting red meat.
Gastroparesis is a neurological disorder that affects the rhythmic contrac-
tions of the intestinal tract. The digestive tract is often called the “second brain”
because of the number of nerves centered there, required for gut motility, as
well as the neurohormones that communicate with the brain. Lyme disease is
known to cause inflammation in the nerve bundles that stimulate peristalsis. If
the nerves in the gastrointestinal tract are affected by Lyme disease, gastric
motility in the stomach can be altered. Though most people have milder forms
of gastric distress such as constipation or nausea, severe gastroparesis can cause
wasting due to the patient’s inability to eat without severe abdominal pain.
One of the primary treatments for gastroparesis is intravenous Zithromax, a
common intravenous medication used to treat tick-borne disease as well. While
this medication treats the condition successfully, many in the medical commu-
nity are reluctant to acknowledge that gastroparesis can have an infectious
origin with Lyme disease. Patients with persistent digestive issues should also be
worked up for food sensitivities, small intestinal bacterial overgrowth, parasite
overgrowth, gastric emptying for delayed motility, and yeast overgrowth.
In Summary
The ability of the microbe to mobilize and migrate is the reason Lyme disease
is so complicated. The most reliable attribute of Lyme disease is its lack of
reliability in its presentation and response to treatment. Expect the unexpected.
This infection can’t be treated in a vacuum, managed by separate medical
specialists each focusing on just one aspect of the body. This disease is
multisystemic, requiring a holistic approach with a practitioner who under-
stands its presentation in each organ system. Lyme disease is further compli-
cated by the diversity of infections carried by the tick, each of which has its
own unique set of symptoms.
In the next chapter, I’ll give an overview of the coinfections commonly
seen alongside Lyme disease. It’s vital that coinfections be evaluated and
treated to restore optimal health.
Fever
FEVERS ARE UNDERAPPRECIATED. It’s a gift to be able to elevate our tem-
perature to clear infections and toxins from our bodies. Yet our culture shuts
fevers down with medication, either from fear of the possible deleterious effects
of fever or because we allow ourselves little time to just recover. Deciding one’s
comfort level with allowing a fever to run its course is a personal choice, but
fever will do more to clear an infection than any medication you could take.
When we shut down a fever, we prolong the infection, not only for ourselves but
for the larger population. Research has shown that people who use fever-reducing
medications have a higher viral load and are more likely to spread the flu, even
though their symptoms might be minimized to the point that they are functional
enough to go to work. My personal process has been to let the fever go, as long
as the patient can communicate clearly and drink water. Obviously, dehydration
or a fever that goes beyond six or seven days would require more medical
management.
Having been raised by a pharmacist, in a home where over-the-counter
medication was always around for common ailments, I understand the cultural
impulse to reduce the fever. But when I entered naturopathic medical school, I
began to let go of the fear of fever. In fact, there were classes devoted to the
practice of hydrotherapy, which includes a treatment called hot fomentation, in
which body temperature is increased by using hot compresses and using wool
blankets to wrap the patient like a burrito. This was helpful for those who
hovered at a 99°F–100°F (37°C–38°C) fever without fully clearing the infection.
The therapy could get the temperature high enough to provide momentum to
resolve the infection.
Fever therapy is becoming better known, with a number of clinics in Europe
offering it as a treatment. These clinics have been around for a long time, and
their primary patient population is cancer patients. Recently, due to the increase
in persistent chronic Lyme disease, the St. George Clinic in Germany has created
protocols to medically induce fevers in a safe environment; vital signs, hydration
status, and organ systems are monitored in a hospital setting while the body
temperature is raised high enough for a proper duration to kill the pathogen. This
treatment is currently not available in the United States due to FDA regulations.
CHAPTER 3
MORE THAN
JUST LYME
DISEASE:
THE ROLE OF
COINFECTIONS
coinfection is the simultaneous infection of a host by more than
A one pathogen. It has become common to talk about the diverse

population of microbes transmitted by a tick to a human as
coinfections. A tick can carry several pathogens at one time as
it collects them from mammals it feeds on. The next meal, a human, can be
the recipient of not only the bacteria that carry Lyme disease but many other
infections—and this can happen with just with one bite. Those who live in an
area where ticks are endemic can have multiple tick bites over the course of
years, increasing the body load of infections. Coinfections can be found at the
time of a bite if the tick is sent out for testing. A tick may be carrying just one
infection, such as anaplasmosis, which can cause rapid onset of headaches,
neck pain, nausea, and fever. Because the environment in which ticks live has
diverse flora and fauna, however, it’s more realistic to expect more than one
infection in the tick that bites you.
Be aware of the probability of coinfections so you can advocate for
coinfection testing if Lyme disease is suspected. Comprehensive lab work to
understand the infections present in your system is critical to finding the right
54
treatment regimen (we will look at testing in
chapter 4). Each infection has an affinity for certain
tissue types, where disease will settle in; the
Be aware of
infections can also cause overall immune deficiency. the probability
Many will lie dormant in lymphatic tissue, blood of coinfections
cells, nerves, and the walls of blood vessels. It’s
so you can
difficult for a body to fight Lyme disease if other
bacterial, viral, or yeast infections or parasites are
advocate for
also depleting the body. We all carry infections we coinfection
contracted in childhood or at other times of life, such testing if Lyme
as infections caused by the herpes family of viruses,
disease is
and these add to the complexity of tick-borne illness.
It’s hard to say how many patients have coinfec-
suspected.
tions because testing tends to be unreliable in
capturing all of the infections, due to the variability of individual immune
responses, strains for which testing may not be available, and the overlap of
symptoms among the different infections. One of the most accurate ways to
identify exposure to a coinfection is to test the tick, if it is found. TickReport
(www.tickreport.com), a testing center affiliated with the University of
Massachusetts, Amherst, publishes a Tick-borne Diseases Passive Surveillance
list, which breaks down the rate of infection in the ticks tested. The database
logs test results from tens of thousands of ticks collected since 2006 in the
United States and Canada. The most prevalent positive infections found in the
ticks collected, in order of highest to lowest rates, are Borrelia burgdorferi,
anaplasmosis, and Babesia species.1
I find coinfection testing is frequently overlooked in the average primary
care office. In my office, I request not only the Lyme disease Western blot, but
also commercial lab testing for most of the common coinfection strains that
can be idendified. If tests are positive, the infection is present; but if it’s
negative, it does not mean there is no infection—a confusing and frustrating
concept. Most patients are diagnosed based on tick bite history, physical
symptoms, and lab work. Sometimes the diagnosis is clear, and sometimes it is
not. This is not always a comfortable place for patients or doctors to be.
An Act of Trust
Patients must take a leap of faith and trust a naturopathic doctor who diagnoses
Lyme disease when the larger medical system does not seem to recognize the
infection. If a patient is ill with all the signs of persistent infection, I’m doing
55
my job as a doctor to treat that infection. I only do so if there is sufficient
clinical evidence of infection, though; as I noted, negative lab results are not
definitive. I must also rule out other conditions, such as autoimmune disease;
however, these can be present simultaneously with tick-borne infections.
Coinfections create a complex constellation of health issues for most patients.
There is much debate about which infection is the primary one and which is
the coinfection, and the way these infections manifest is highly individual.
Tackling several infections can make the road to recovery very long, but
healing is greatly improved when the patient stays open to the process and
persists with treatment.
This overview breaks into categories—bacterial, viral, fungal, and parasitic—
the infections commonly partnered with chronic Lyme disease. Information
in this chapter is based on my clinical experience and research. The treatments
discussed are merely options and are not limited to these examples. In most
cases, both antibiotics and natural medications are required to recover fully
from these infections. I list both forms because I use both in my practice.
Bacterial Coinfections
This section will guide you to a better understanding of the common bacterial
coinfections seen in clinical practice. It’s important to understand their chief
indicators and typical symptoms in order to minimize fear: The most difficult
aspect of tick-borne disease for patients is the fear associated with experienc-
ing the unexplainable. These infections can have distinct presentations,
almost like personality characteristics, which can be identified with specific
symptoms; but patients are often told by doctors that what they are experienc-
ing is not related to tick-borne infection. A better understanding of coinfec-
tions can help you identify your possible symptoms and know how to
communicate your concerns to your providers.
B A R TO N E L LO S I S
Of the more than twenty-six Bartonella species confirmed, the most infectious
to humans are B. henselae, B. quintana, and B. bacilliformis. Bartonellosis is
commonly associated with cat scratch fever. Often a localized skin infection
that occurs after the bite or scratch from an infected cat, it can also become a
systemic infection. This bacteria has been found in ticks in the United States,
Europe, Asia, and the Middle East. 2 B. quintana primarily infects humans,
whereas B. henselae is found in both humans and cats. 3 Cats acquire the
disease from fleas and ticks.
Once the infection enters the human body, it infects red blood cells and the
lining of vascular walls. The microbe itself has some ability to move through
tissue, though not as efficiently as a spirochete. Bartonella produces an
endotoxin while attaching to the interior of blood vessels with arm-like
projections. Its presence stimulates inflammation in the body, which weakens
vascular walls. The protein vascular endothelial growth factor (VEGF), a
testable marker in the blood, is stimulated by B. henslae, increasing capillary
growth in a condition called angiogenesis. This causes the growth of new
vessels that are not necessary to the functioning of the body. Patients can
rapidly develop capillaries under the skin, creating spider veins. Spider veins
are not uncommon in those prone to them, but sudden onset is not common
and should alert you to seek medical attention to address the cause. Part of the
medical workup should be testing for Bartonella species.
The research on treatment for bartonellosis is all over the place, with some
studies saying it’s treatable and others claiming it is resistant to therapies. I
have patients who improve with aggressive treatment, while other patients
experience a prolonged and difficult recovery; but this is true of many
infections. If not found early, Bartonella infections can require a lengthy
recovery time, as is true of Lyme disease.
Symptoms: Among the most difficult symptoms of Bartonella are the
mental and emotional changes; common behavioral changes include increased
anger and obsessive-compulsive thinking. Patients may also tend toward
addiction issues and violent thoughts. Mood-enhancing medications do not
seem to work as well for those infected with Bartonella.4 Patients often have a
harder time reading and tracking information with their eyes and have many
symptoms concerning visual acuity. They may be more sensitive to light, see
flashes of light in their field of vision, and have eye pain and/or blurred vision.
For school-age patients, grades will suffer and they may experience a loss of
confidence. Those who have bartonellosis may also be diagnosed with attention
deficit, show autism spectrum–like behaviors where there were none before, or
demonstrate hyperactivity or antisocial behaviors. Other common complaints
are numbness and tingling, shooting pains, electrical shock sensations,
vibrations down the extremities, enlarged lymph nodes, lumps forming under
the skin, walking abnormalities, inflammation in the heart muscle, intense
pain, weakness in the lower limbs, loss of muscle tone, hypermobility mimick-
ing Ehlers-Danlos syndrome type II, rashes, and behavioral changes. 5
All sort of rashes may appear with bartonellosis. Random lines may show up
in areas where no skin contact created them. Or the rash can look like stretch
marks, with gender-specific patterning: males have lines across the back in a
horizontal pattern, while females typically have them around the armpits, hips,
and down the thighs. These are present in cases where there is no associated
M O R E T H A N J U S T LY M E D I S E A S E : T H E R O L E O F C O I N F E C T I O N S 57
weight gain that would cause the marks. A chicken wire pattern on the skin or
dramatic changes in skin color with intense red and purples may occur, with the
skin then returning to normal. Other symptoms include clusters of capillaries
that appear randomly, sprouting up overnight; poorer circulation and a condi-
tion called Raynaud’s syndrome; low-grade fevers that come and go throughout
the day; enlarged lymph nodes throughout the body that enlarge and shrink in a
chronic cycle; and burning sensations in the limbs and mouth.
Blood tends to be thicker in those with bartonellosis, and the vascular
system is affected due to an immune response that causes excess proteins to
be created. Blood can appear like syrup, witnessed when taking a blood
draw—this is obvious, as it takes longer for the tubes to fill. Patients have
increased pain due to the poor circulation caused by the blood vessel injuries
and thicker blood. Natural or pharmaceutical blood thinner can be of assis-
tance here, with proper medical management.
Treatment options: Pharmaceutical medications—sulfamethoxazole-
trimethoprim (Bactrim), rifampin, doxycycline/minocycline
Natural treatments—Houttuynia, gou teng (Unicaria rhyncophylla),
L-arginine, garlic, pokeroot, sarsaparilla, Angelica sinensis, skullcap, cordyceps,
glucosamine, white peony root, kudzu. For blood thinning and endothelial
repair: nattokinase, fish oil, lumbrokinase, serrapeptase, bromelain, quercetin,
resveratrol
E H R L I C H I O S I S/A N A P L A S M O S I S
Human monocytic ehrlichiosis and human granulocytic anaplasmosis are very
similar in their presentation. Their primary cellular targets are monocytes,
macrophages, and leukocytes, which are all part of the family of white blood
cells. These bacteria enter the white blood cell and reprogram it to serve the
bacteria’s purpose of survival.6 Our immune system has a difficult time with
this change, which allows other fungal, parasitic, viral, or additional bacterial
infections to become more problematic.
The good news is that these infections are highly treatable. Ehrlichiosis
is noted to be transmitted by the Lone Star tick, and anaplasmosis by the
deer tick, Ixodes scapularis. Ehrlichiosis is most commonly found in Missis-
sippi, Oklahoma, Tennessee, Arkansas, and Maryland. I have seen many
patients with positive ticks in New Hampshire and Massachusetts as well.
Anaplasmosis is primarily found in New England and the north central
United States.
Symptoms: Ehrlichiosis and anaplasmosis are infections with a rapid
onset, causing people to seek medical care immediately. Typically, within a
day or two of the bite, patients run a high fever (103°F–105°F [39°C–41°C]).
Then neck pain, respiratory issues, elevated liver enzymes, headaches, muscle
pain, joint pain, rashes (specifically with ehrlichiosis), abdominal pain, nausea,
and vomiting follow. Meningitis and encephalitis are also common and require
in-hospital medical care. Nerve involvement may also occur, with facial palsy
and loss of sensation in different parts of the body. There can be inflammation
within organ tissues, including in the spleen, kidneys, and heart.
Many patients are diagnosed with viral meningitis, as the presentation of
fever, intense neck pain, nausea, and headache is similar. Ehrlichiosis and
anaplasmosis may not be tested if a viral cause is assumed. The patient is
usually cared for in a hospital setting, given fluids and medical support until
the symptoms improve enough for the patient to be released. However, as time
goes by, the patient reports relapses, with continued body pain, headaches,
and cognition and neurological issues because they are actually suffering from
a bacterial infection that requires treatment with antibiotics.
Treatment options: Pharmaceutical medications—doxycycline/minocy-
cline, rifampin
Natural treatments—Sho-saiko-to, reishi, Maitake Gold Fraction, green tea
extract, arabinogalactan, elderberry, olive leaf extract, liposomal glutathione,
artichoke, milk thistle
R O C K Y M O U N TA I N S P OT T E D F E V E R
Telling a patient he is positive for Rocky Mountain spotted fever (RMSF) is
very difficult because the first thing you see when you jump online to research
this disease is “death.” I do not wish to downplay the severity of the RMSF, but
I see patients test for this disease, caused by the bacterium Rickettsia rickettsii,
at least two or three times a week. Most patients will be Lyme disease positive
as well. I treat patients aggressively and see titers decrease within two to
three months’ time.
RMSF is considered one of the most commonly acquired and lethal
Rickettsia infections in the United States. It’s transmitted by a variety of tick
vectors in the United States, including the American dog tick (Dermacentor
variabilis), the American wood tick (Dermacentor andersoni), and the brown
dog tick (Rhipicephalus sanguineus). Other Rickettsia infections are R. parkeri,
R. phillipi, R. massiliae, and possibly R. montanensis and R. amblyommii.7 While
RMSF is regarded as more prevalent in southern U.S. states, most of my
patients who are positive have never visited the South. A lot of current
research is focused on RMSF in Mexico.
In the body, RMSF is an intracellular bacterial infection that invades blood
vessels of medium size.8 Patients typically experience symptoms four to ten
days after a tick bite; tick attachment time is four to ten hours to transmit
disease. As with Lyme disease, proteins within tick saliva can boost transmis-
sion of the infection.9
Symptoms: New infections commonly present with headaches, fevers,
chills, nausea, and abdominal pain. If the disease becomes chronic, mental
confusion, hepatitis, cardiovascular inflammation, and rashes on the arms/
legs can also occur. Neurological manifestations include altered gait, short-
term memory loss, stuttering, sensitivity to light, and emotional instability.
cline and rifampin. Tetracycline medications are not indicated typically until
after the age of eight to ten years. The use of medications in the tetracycline
family can cause softening of the teeth, which alters adult dentition. I have
seen improvement with the use of sulfa medications in young children, even
though the literature does not support this at this time. The recommended
treatment time in the literature is seven to ten days; however, I usually treat
longer, until symptoms are resolved. Because of the severity of the antibiotic
medication, I strongly recommend that natural medication support be
implemented as well.
Natural treatments—resveratrol, olive leaf extract, quercetin, horse
chestnut, hesperidin, rutin, lomatium, cryptolepis, and gou teng (Unicaria
rhyncophylla). My recommendation is to use natural medicine in conjunction
with prescription medications rather than alone, due to the risk of complica-
tions. The goal is to treat the vascular system and the immune system.
Q FEVER
Discovered in Australia in 1937, Q fever is also known as Coxiella burnetii, or
query fever. It’s prominent in the United States, the tropics, the Netherlands,
and the Middle East. A small intracellular bacterium shaped like a ball,
Coxiella burnetii is highly adaptable to stressful situations in the body. It has a
dense, interwoven structure, which helps it maintain stability. These bacteria
can survive for seven to ten months in wool garments at ambient temperature,
for more than one month on fresh meat, and for more than forty months in
milk.10 They have also been known to survive in low concentrations of
formaldehyde solution, a common preservative for tissue samples. The
take-home is that it’s a survivor. The good news is that it does seem to be
susceptible to antibiotics.
The most common modes of transmission are from inhalation of particles
of amniotic fluid after birth of new livestock, tick bites, and ingesting food that
harbors the bacteria. The main reservoirs are cattle, sheep, and goats.
Ticks were first recognized as a reservoir in Montana in the hard-bodied
tick species D. andersoni. C. burnetii has since been found in forty different
hard-bodied tick species, several soft-bodied tick species, flies, mites, and bed
bugs.11 The microbe lives in the gut, salivary glands, and ovaries of the tick
species for long periods of time. The stress on the tick—dehydration and
minimal feeding—does not seem to affect the presence of infection. Q fever
can be found in tick feces as well. Ticks collected in an urban park in Italy
were found to have a triple coinfection of Rickettsia species, B. burgdorferi
species, and C. burnetii.12 This result underscores my earlier note that the most
effective way to determine infectivity is by testing the ticks.
Symptoms: Q fever can last up to fourteen days in acute form and may
also persist as a long-term chronic infection. Its initial symptoms are fevers,
headaches, fatigue, and muscle pain, with more severe symptoms including
endocarditis, hepatitis, meningitis, pneumonia, and chronic fatigue. Older
men tend to be more symptomatic than women. Severe complications in
pregnancy and childbirth can occur, with the infection able to replicate in the
placenta. This can cause many birth complications and abnormal development
of the fetus. Even after the baby is born, the infection can stay in the mother’s
body and infect the next pregnancy if she is not treated.13
When contracted in childhood, the disease is less symptomatic than it is in
adults. It can look like a common cold. High fevers can last more than fifteen
days; other symptoms include cough, joint pain, muscle pain, abdominal pain,
nausea, severe headaches, elevated liver enzymes, Guillain-Barré syndrome,
peripheral neuropathy, rashes, enlarged lymph nodes, elevated autoimmune
markers in blood, and chest pain with breathing.
cline plus hydroxychloroquine, sulfamethoxazole-trimethoprim
Natural treatments—olive leaf extract, garlic, lomatium, Sida acuta, golden-
seal, Oregon grape root, Hoxsey-like formula, homeopathic nosode of Q fever
FRANCISELLA TULAREMIA
Infection with Francisella tularensis is commonly known as rabbit fever, with
the primary vector being cottontail rabbits and hares. This disease saw a peak
of infectivity in the early 1900s, with some outbreaks in North America in the
1980s and early 2000s. The bacteria are transmitted via ticks and biting flies,
but can also be contracted if a person consumes infected food or water or
inhales particles in the air. The infection typically has a quick onset of two to
six days but can take up to twenty-one days to manifest.
Symptoms: New infection presents with fever, rashes, nausea, muscle
pain, cough, vomiting, sore throat, enlarged lymph nodes in the neck, abdomi-
nal pain, and pneumonia-like symptoms. There can be an ulcerative lesion at
the site of the bite, with lymph node involvement.
Treatment options: Pharmaceutical medications—intravenous gentamicin,
intramuscular streptomycin, and oral doxycycline
Natural treatments—olive leaf extract, garlic, lomatium, Sida acuta, goldenseal,
Oregon grape root, Hoxsey-like formula, Maitake Gold Fraction, green tea extract
Other Bacterial Infections
While Mycoplasma pneumonia and Chlamydia pneumonia are commonly
passed around within the human and animal population, peer-reviewed
studies have shown the prevalence of both infections within ticks of the Ixodes
species. A study published in Applied Environmental Microbiology in 2015 used
DNA sequencing to find proof of Chlamydia species with ticks.14 Mycobacte-
rium species were determined to be the cause of body pain, fatigue, and
cognitive issues without any other sign of Lyme disease soon after a tick bite.
After treatment for Mycoplasma, symptoms abated.15 There is so much we do
not know about what ticks carry and transmit. Investigating the presence of
these two infections is important in symptom management and recovery.
M YCO P L A S M A P N E U M O N I A
Mycoplasma pneumonia, sometimes called walking pneumonia, is a common
finding on patients’ lab results, showing that a majority of my patients have
been exposed at some point in their lives. Most of the time, Mycoplasma
pneumonia presents with antibodies signaling past infection rather than as a
current acute disease. Common in the human population, this infection is
typically transmitted from human to human through contact with respiratory
fluids. It tends to cycle through the population every five to seven years but
can have a decades-long incubation period before it reemerges. It’s a very
small bacterium that adheres to respiratory tissue and requires our cholesterol
for survival, and its cell structure can make certain antibiotics less effective.
This type of pneumonia can be severe enough to cause hospitalization or so
mild that its main symptom is a persistent cough.
Mycoplasma pneumoniae is important to consider in conjunction with
chronic Lyme disease because infection with this bacterium creates a more
difficult recovery for someone with Lyme, as the coinfection can cause
breathing difficulty, fatigue, muscle pain, and, for some reason, a high
propensity for hair loss in women.
Symptoms: Mycoplasma pneumonia can cause chronic arthritic and
neurological symptoms, and is a cofactor in developing rheumatoid arthritis16
as well. Joints affected are knees, shoulders, elbows, and wrists, which will be
swollen and warm to touch. This is thought to be due to direct exposure to the
microbial toxins, which cause an immune reaction in the host and lead to tissue
damage. Nervous system involvement usually starts with respiratory infection,
with the most common manifestation being inflammation around the brain and
the nerves throughout the body. The eyes are also affected, with increased risk
of optic neuritis or double vision.17 It is important to check the active status of
this infection in those who may have tick-borne disease, especially if the
person is short of breath or has a persistent cough.
Mycoplasma pneumonia can lead to a chronic cough that lasts months or
years as well as an increased risk of developing asthma. It also comes with
increased risk of severe skin reactions, hemolytic anemia, or severely low
platelets. This infection has also been associated with inflammatory bowel
disease18 and Crohn’s disease.19
Treatment options: Pharmaceutical medications—tetracycline and macro-
lides. Does not respond to rifampin, penicillins, cephalosporins, or sulfonamides.
Natural treatments—olive leaf, lomatium, garlic, elderberry, bromelain.
Natural expectorants are N-acetyl-cysteine (NAC), bromelain, and guaifene-
sin. For persistent cough, use Old English Ivy tincture or thyme tea. Herbals
that support neurological tissue such as bacopa, phosphatidylcholine, tur-
meric, tianma (Gastrodia elata Blume), gou teng (Unicaria rhynocophylla),
yarrow, Rhodiola rosea.
CHLAMYDIA PNEUMONIA
Commonly acquired in childhood, Chlamydia pneumonia can persist into
adulthood when the person’s immune system is compromised. This is a
common infection to test when Lyme disease is present, to get an understand-
ing of bacterial load that might make recovery more complicated. These
bacteria behave in the body like parasites; they are taken into a host’s immune
cells and use the host cell energy to survive. Most bacteria require amino acids
to survive, and Chlamydia pneumoniae is no different. The infection does best
when the amino acids we rely on for maintaining proper health, such as
methionine or lysine, are low.20
Chlamydia pneumonia is a very common infection, affecting 50 percent of
the population, with acute infection affecting mostly young people. Men seem
to be affected more than women. Humans are the primary reservoir, passing
the infection through mucous droplets released in the air. This is a concomi-
tant infection, meaning that it occurs or exists at the same time as another
infection, and it is enhanced by other systemic infections such as Lyme
disease. A patient can carry the disease and be asymptomatic, but it will
resurface if person’s immunity is reduced.
Symptoms: pharyngitis, sinusitis, cough, fever, hoarse voice; associated
with increased risk of coronary artery disease, sarcoidosis, asthma, and
reactive arthritis
Treatment options: Pharmaceutical medications—macrolides and
doxycyline/minocycline
Natural treatments—lysine and methionine, elderberry, cordyceps, Maitake
Gold D-fraction, astragalus, bromelain, reishi, N-acetyl-cysteine (NAC)
Microbial Diversity in Ticks
THERE ARE MORE UNKNOWNS THAN KNOWNS when it comes to tick bites.
I always warn patients not to get too fixated on Lyme disease—unfortunately,
Borrelia species are far from the only pathogens ticks carry. Tick microbiomes,
like those of humans, are incredibly biodiverse; and we are just beginning to
understand how varied a tick is as we sequence its genome. If a tick is carrying
multiple microbes, it is nearly impossible for Lyme spirochetes to be the only
microbe transmitted. In fact, when larval ticks fed from mice treated with
gentamicin (an antibiotic), they went through dysbiosis, which slowed their
interest in feeding quite dramatically. 21 This is similar to the cravings or changes
in appetite we humans face when our microbes are altered.
By understanding the pathogens in the ticks found in a given area, we can
attempt to stay on top of diseases that could eventually make their way into the
human population instead of chasing infections after the fact. As the climate
continues to change, leading to longer spring/autumn seasons, and the environ-
ment is less agricultural and more urbanized, ticks will migrate farther north and
have longer periods of high activity. Because the tick microbiome is dependent
on geographical location, the tick will be introduced to new infections.
Other factors also affect the tick microbiome, including gender—male ticks
have more genetic variation in their microbiomes than female ticks. Thankfully, a
majority of the microbes in the tick midgut are nonpathogenic, just as in the
human microbiome.
Ongoing research is looking at the tick immune system and its microbiome in
relation to the microbes being transmitted and how coinfections emerging in
endemic areas behave within the tick.
Viral Coinfections
There are more viral proteins on the planet than any other microbe. It’s
important to investigate these infections with testing because their opportu-
nistic nature and ability to increase inflammation markers in the body make it
difficult for a person with both a viral infection and Lyme disease to regain
health. Following is an overview of the most common viral infections tested
for and commonly treated in my clinic. When I say treated, I mean that we
offer medications to slow replication of the virus, not that we cure it. Viruses
are with us for life.
Viruses persist by replicating virions, which infect cells. Virions are
programmed proteins floating freely in the environment, like multitudes of USB
drives floating in space. They then plug themselves into the cellular membrane
of a compatible cell, and the data are uploaded into the RNA/DNA of the cell.
This new information causes our DNA, the program model for our cells, to
change cell structure and behavior. These changes can create discomfort in the
body in the form of illness, but in many cases these data support life on the
planet through the sharing of information. For example, a virus is responsible
for the expression of the protein syncytin, which helps in creating a healthy
placenta for the growth and development of fetuses in mammals, humans
included.22 When we hear the word virus, we think of illness and suffering, but
viruses have been here since the beginning of life on the planet. The data they
carry are far vaster than we can imagine and benefit our survival by educating
our bodies to adapt to the ever-changing environment.
As part of an initial assessment of a patient, I check titers for the common
viral infections herpes simplex virus I/II, Epstein-Barr, cytomegalovirus,
parvovirus, and human herpesvirus 6. Viral replication can increase when the
body is run-down with other infections. Recovery from Lyme disease will be
more difficult if these viruses are not addressed.
Because the treatment for viruses is the same in each case, I am including
the options here rather than for each virus separately.
Treatment options: Pharmaceutical medications—valacyclovir and acyclovir
Natural treatments—Lemon balm, L-lysine, propolis, Andrographis
paniculata, Astragalus membranaceus, Houttuynia cordata, olive leaf extract,
vitamin A, lomatium, cryptolepis, garlic, Maitake Gold Fraction, goldenseal,
oregano oil, neem, vitamin C, Polygonum cuspidatum, Scutterlaria, phosphati-
dylcholine, medium-chain triglycerides
P OWA S SA N V I R U S ( T I C K- B O R N E E N C E P H A L I T I S )
Powassan virus was first found in a young boy in Powassan, Ontario, in 1958
and is the only tick-borne encephalitis in the United States. It’s transmitted by
Ixodes scapularis in the northeastern United States and Ixodes cookei in the
Midwest and Canada. Transmission can occur within three hours of a person
receiving a tick bite. Tick saliva enhances the transmission of the viral
infection, which shows an affinity for the brain tissues and causes inflamma-
tion in the brain, leading to meningoencephalitis, encephalitis, and aseptic
meningitis.23 This virus has been found in Europe and Canada and has been
confirmed in New York and Pennsylvania; there has been a 671 percent rise in
this infection over the past eighteen years. 24
Tick-borne encephalitis is more prevalent in Russia and Europe, with
10,000 to 13,000 cases confirmed in those regions annually,25 with 90 percent
developing flulike symptoms and the other 10 percent
developing more severe neurological manifestations.26
Herpesviruses A vaccination is available for forms of tick-borne
are opportunis- encephalitis found in Eastern Europe and Russia, but
tic infections there is no formal treatment for Powassan/tick-borne
encephalitis. The primary focus is symptoms manage-
that replicate
ment at the time of acute onset, with hydration, pain
more aggres- management, anti-inflammatories, antivirals, and
sively when the steroids. Ongoing neurological deficits can occur and
body’s vitality can ideally be managed by natural medications to
enhance immunity and reduce neuroinflammation.
is weakened …
Symptoms: Infection of the brain and meningitis.
Usually, intense headaches, high fevers around 105°F–106°F (41°C), nausea,
intense neck pain, altered speech, loss of limb function, memory loss,
and seizures are among the symptoms of Powassan virus and tick-borne
encephalitis.
HERPESVIRUSES
There are eight herpesviruses infectious to humans. These are classified into
three categories: alpha-herpesviruses, beta-herpesviruses, and gamma-
herpesviruses. Alpha-herpesviruses are quick replicators and include oral
herpes (herpes simplex virus I), genital herpes (herpes simplex virus II),
and chicken pox (varicella zoster). Beta-herpesviruses include cytomegalo-
viruses and human herpesvirus 6, which are slower to replicate. The
gamma-herpesvirus that most concerns Lyme disease patients is Epstein-
Barr virus, which acts almost like a parasite, infecting 6.5 billion people
around the world. Herpes viruses have been traced back over two hundred
million years. 27
Herpesviruses seem to have an affinity for nerve tissue and specific cells
of the immune system. When borne by ticks, each of these infections has
similarities of presentation, including fatigue, nerve pain, rashes, sweats,
muscle pain, and fevers. Herpesviruses are opportunistic infections that
replicate more aggressively when the body’s vitality is weakened, and viral
replication becomes more active in someone who is experiencing chronic
Lyme disease, making recovery more difficult. It’s important to test for these
infections and treat them at the same time other tick-borne infections are
addressed with natural antiviral medication and, if necessary, prescription
antivirals. In clinical settings, doctors are more likely to test for Epstein-Barr
or other herpes viral infections, assuming the patient only has a virus when he
actually has Lyme disease. In most cases, both are present.
Cytomegalovirus (CMV)
Cytomegalovirus (CMV), or human herpesvirus 5, poses the greatest difficulty
for newborns and those who are immunocompromised. Symptoms in this
population can include liver and spleen involvement, rashes, and inflammation
of the retina, blood vessel walls, and the smooth muscle of the kidneys. These
symptoms especially affect those with lower levels of an important immune
cell type called natural killer cells, which are cells that attack a foreign invader
immediately after it enters the body. They are our first line of defense.
CMV can go into long periods of inactivity, reemerging when it senses the
body is in a state of compromise and stress. It also has the ability to reprogram
lymphocytes—a type of white blood cell that is part of the immune system—
to dissuade them from attacking. 28 As cells are invaded by the virus, they can
appear larger, hence the name cytomegalovirus. It’s also associated with
Guillain-Barré symptoms and peripheral neuropathic pain.
There is an interesting dynamic in the relationship between cytomegalovirus
and multiple sclerosis (MS). We typically believe that viruses are harmful to our
health; however, researchers have hypothesized that CMV is immune-protective
with regard to MS. Reduced MS symptoms and the presence of CMV are strongly
correlated in MS patients.29 This could represent a breakthrough, leading to
more research on the benefits some viruses may yield.
Symptoms: Symptoms can be barely perceivable when the disease is
acquired, with slight lymph node enlargement, low fever, and fatigue. A
hallmark of the disease is relapse and remission cycles, in which the disease is
shed in tears, sweat, blood, urine, semen, and breast milk. The disease is
transmitted when body fluids of an infected person come in contact with the
mucous membranes of another. Congenital transmission can cause hearing
loss, visual impairments, seizures, and mental/physical disabilities in immu-
nocompromised infants. Risk factors in adults with CMV and other diseases
that compromise the immune system, such as Lyme disease, can be hepatitis,
enlarged spleen, pneumonia, and encephalitis.
Herpes Simplex Virus I and II

With herpes simplex virus I and II, lesions are typically found on the surface
of the skin around the mouth and genitals. Initially, an acute crop of lesions
appears together with nerve pain. This is when it is most contagious, spread
from person to person with direct skin contact. Blood work and swabs from
new lesions can confirm the strain of infection. Although it’s commonly
assumed that herpes type I only creates lesions on the mouth, it can cause
genital herpes as well. Herpes I and II have an affinity for sensory nerves,
where they can go dormant, reemerging during times of stress.
Herpes simplex has been associated with encephalitis and inflammation in
the temporal lobes of the brain. It can also cause headaches, fevers, and
changes in speech and behavior. 30 The skin lesions can continue to flare,
brought on by stress and/or dietary triggers such as foods high in L-arginine
(including coffee, cheese, and red wine). Herpes simplex is transmitted with
skin-to-skin contact when an infected person has an active lesion. Individuals
with herpes type I/II will have more superficial outbreaks after acquiring
Lyme disease, though they might have gone years without having an active
infection. Again, this is due to compromise of the immune system.
Symptoms: Nerve pain, headaches, fevers, lesions that can be oral as well
as genital, with initial tingling or burning at the site before the lesions fully
manifest. There can also be intense pain at the site of the lesions, ear pain, and
facial palsy. The reactivation of herpes simplex virus can complicate the
picture for Lyme disease with nerve pain and lymph node involvement.
Herpes simplex virus also can cause vagus nerve palsies or temporary
paralysis, leading to difficulty swallowing and speaking clearly.
Human Herpes Virus 6 (HHV-6)

Human herpesvirus 6 (HHV-6) infection, commonly referred to as roseola, is
contracted early in childhood, between the ages of six months and twenty-
four months. It’s characterized by a “slapped cheek” appearance, with a red,
raised rash that appears after a high fever; irritability; and ear pain. It can
also cause febrile seizures, which can happen when fevers are too high, but
seizures have not been found to be linked to the development of more severe
forms of epilepsy. A reactivation of HHV-6 in an adult can be linked to
encephalitis or meningitis. 31 HHV-6 has also been found postmortem in the
brain tissue of individuals with MS and is theorized as a contributor in the
progression of the disease. HHV-6 is diagnosed after the virus is identified in
cerebrospinal fluid. This test is most commonly run in patients suffering from
symptoms of encephalitis. It will also attack specific cells of the immune
system, including microglial cells of the brain, lymphocytes, and natural
killer cells.
Symptoms: Chronic fatigue syndrome or mononucleosis-like symptoms,
abdominal discomfort, upper respiratory infection, chronic enlarged lymph
nodes, anemia, arthritis, rashes, irritability, thyroid dysfunction, and periph-
eral neuropathies. The majority of people who carry this virus present with no
symptoms at all.
Epstein-Barr Virus
Just about every patient, regardless of whether he has Lyme disease, has
been exposed to Epstein-Barr virus, with more than six billion infected
people on the planet. A majority of my patients have
positive titers for Epstein-Barr, with a majority
experiencing chronic active Epstein-Barr syn-
Just about
drome. I test all patients, not to evaluate whether every patient,
they have the virus but to get a baseline of their regardless of
titers. It’s weird if someone is negative, and it leaves
whether he has
me wondering how they escaped such a common
viral infection.
Lyme disease,
Epstein-Barr virus will reactivate when the body has been
is under stress from other diseases or life situations. exposed to
Known as mononucleosis, the more pronounced form
Epstein-Barr
of Epstein-Barr is also referred to as the “kissing
disease” because of its affinity for the tonsils, which
virus, with more
allow it to be transmitted in saliva. It likes to make than six billion
its home in the lymphocytes (white blood cells) and infected people
lymphatic tissue (tonsils) and has been linked to an
on the planet.
increased risk of developing certain forms of cancers,
or lymphomas.
Research published in Nature Genetics in 2018 found that Epstein-Barr
virus increased a person’s risk of developing lupus, rheumatoid arthritis,
inflammatory bowel disease, type 1 diabetes, and celiac disease. 32 The
interaction of Epstein-Barr with the human immune system alters gene
expression, increasing the likelihood that an individual will develop one
or more of the conditions. It can also cause the myelin around nerves to
degrade, creating numbness and tingling throughout the body due to
chronic inflammation. 33
Frequently, patients have both mononucleosis and a positive Western blot
for Lyme disease. This can be confusing because mononucleosis can cause
swollen glands, fevers, muscle pain, debilitating fatigue, and sweats—but so
can Lyme disease. Mononucleosis is diagnosed more often because it’s more
readily tested in conventional clinical settings. If the confirmatory test for
mononucleosis is negative, the diagnosis is often subclinical mono, and the
patient is sent home to rest and recuperate with no further testing. Many
patients are treated with immunosuppressant steroids, which, in my opinion,
is the worst medication to give at a time the immune system is trying to fight
an infection. The bottom line is that everyone should be tested for Epstein-
Barr and levels of antibodies tracked on labs to check how much the virus is
contributing to the patient’s ill health.
Symptoms: Fatigue, fever, loss of appetite, rashes, sore throat, enlarged
lymph nodes, enlarged spleen, increased inflammation markers referred to as
unbalanced cytokine response, 34 night sweats, and low natural killer cell counts.
Varicella Zoster
Varicella zoster, or chicken pox, is a virus transmitted by direct contact or by
droplets of mucus breathed into the air by an infected person. Later in life, this
virus can resurface as shingles, or herpes zoster. Before the vaccine was avail-
able, nearly everyone got chicken pox, and parents went out of their way to have
their children infected just to get it over with. When children are infected, they
typically recover within a couple of weeks, whereas those who are first infected
in adulthood can become more severely ill. I do not often see shingles in my
office, yet patients do report a history of having had it in the past.
Symptoms: Headaches, fever, malaise, and rash over the entire body
lasting two to three weeks, usually in childhood. Later in adulthood, patients
can develop multiple vesicles with blisterlike presentation along a sensory
nerve root or a dermatome. These can be weeping and then crust over to heal
within one to two weeks’ time. This usually follows a stressful event or another
illness that causes immune compromise. These can form anywhere on the body
but are most common along the waistline or on the trunk of the body on one
side. Outbreaks can also occur on the hands, with pain and vesicles called
herpetic whitlow. This virus, over time, can lead to immune compromise.
H U M A N PA RVOV I R U S B 1 9
Human parvovirus B19 was discovered in 1974. It’s the only infection in the
parvovirus family that is pathogenic to humans; another type of parvovirus is
well known as a canine infection. Parvovirus B19, also known as fifth disease,
is transmitted by droplets in the air, via blood, or from mother to baby. In
children ages one to five, the virus begins with a fever and ends with a rash.
This virus becomes more problematic if it’s transmitted in utero, as it has the
potential to cause miscarriage due to infection of the placenta.
In chronic persisting infections, there can be symmetrical swelling of
joints, which is typically seen in rheumatoid arthritis. It can also cause
aplastic anemia, a condition in which the body temporarily stops making red
blood cells. Parvovirus B19 should be considered as a potential additional
cause when joint swelling with symmetrical appearance occurs in those with
Lyme disease; often, this is mistakenly diagnosed as rheumatoid arthritis.
Symptoms: In early childhood, parvovirus B19 is referred to as “slapped
cheek” disease due to the facial rash. Common symptoms in youth are fever,
upset stomach, headache, and runny nose. Blood work shows anemia. The
virus can also cause arthritis and can look a lot like Lyme disease arthritis.
The viral timing is spring and winter, with joint manifestation happening a
few weeks after infection, coinciding with ticks’ more active periods in
endemic areas. There can be increased swelling in the joint as well as morning
stiffness similar to osteoarthritis.
Fungal Coinfections
Commonly seen as unappealing, funguses are often associated with disease.
However, some funguses are becoming more widely admired for their
complex communication networks and other qualities—such as the ability to
eat plastics—that could be helpful on a global scale. This section, however,
focuses on the pathogenic Candida (yeast) species that colonize the skin and
mucosal surfaces in cases of immune compromise.
Mucosal surfaces are those that are more pink, sensitive, and lubricated,
such as the oral cavity, sinus cavity, vaginal canal, and digestive tract. This
differs from outer skin surfaces and nails, which have a protein called keratin
that creates a strong barrier on the outside. This barrier can withstand friction
and temperature changes, and is waterproof. Candida can colonize internally
or externally, but other skin fungal infections—including those caused by
dermatophytes or Tinea species—colonize the keratinized tissues. These
infections include ringworm and nail fungus.
Funguses such as Candida albicans are present within the healthy human
flora and can be introduced into the body when a person eats contaminated
food. Funguses such as Aspergillus species can be inhaled through spores in
the air in certain areas of the country. Dermatophytes are acquired externally
by physical contact with the skin of the foot, such as when a person walks on
the floor of a shared gym shower.
Opportunistic yeast species pathogenic to humans include C. albicans and
C. glabrata, but there are more than two hundred species of yeast. 35 Only
certain strains can exist in the gut, which has low oxygen and a temperature
too high for most strains. Part of the normal gut flora, yeast can get out of
balance when a person’s immune system is compromised due to infection,
toxic overload, or improper diet. The Candida cell looks like an oval, and when
it reproduces (asexually), a bud extends off its body and is eventually released
as a new yeast cell. Yeast loves sugar and thrives in areas where the pH does
not support healthy growth of Lactobacillus and Bifidobacterium species, two
of the most prolific beneficial bacterial strains in the body that help maintain
healthy yeast population numbers. Yeast can also create biofilm slime, which I
talked about in chapter 2.
Symptoms: Clinical presentations depend on the area affected. Many
patients have a history of repeated vaginal yeast infections or athlete’s foot.
Outer skin manifestations of yeast imbalance can be redness, often called a
“red, beefy rash,” cracked skin, peeling, itching, and darker skin patches that
look like dry circles with a tan appearance. Some dermatophytes of the skin
are slow growing and are difficult to treat, especially nail fungus. Areas
commonly affected are skin folds, such as those in the groin, armpits, under
breasts, and in the abdomens of those with more abdominal fat stores. This is
because skin folds tend to have the higher moisture content yeast like. Feet are
also common sites of fungal infections because they are in shoes throughout
the day. Symptoms of vaginal yeast infections are itching, redness, and
discharge. Sinus infections caused by yeast tend to be more persistent because
it is not common to swab the nasal cavity to check for yeast; it is assumed the
infection is bacterial, viral, or allergen driven.
Treatment options: Pharmaceutical medications—topical creams such as
clotrimazole, fluconazole, and miconazole available over the counter; oral
treatment of nystatin and fluconazole; intravenous amphotericin B
Natural treatments—monolaurin, neem, Saccharomyces boulardii, gentian
violet, pau d’arco, caprylic acid, oregano oil, berberine-containing herbs,
probiotics, allicin (garlic), and Pseudowintera colorata (topical Kolorex?)
Parasitic Coinfections
A parasite is an entity dependent on another being that does not provide a
benefit to the host. Almost everyone has a gastrointestinal parasite, which is
not a problem unless it creates digestive distress such as diarrhea, bloating,
weight loss, or malabsorption of nutrients (which means malabsorption of
medications as well). Parasites infectious to humans fall into two categories:
protozoa and helminths. I’ll talk about protozoa first, then tackle helminths
a bit later.
Protozoa are single-cell organisms that move from host to host through an
oral–fecal route, usually through contaminated food, tainted water, or
intimate human contact. They can also be spread by blood-sucking insects, as
with the infection babesiosis. The infections most commonly seen in humans
are giardiasis, cryptosporidiosis, amebiasis (from Entamoeba histolytica), and
malaria (from Plasmodium species). Protozoa have erratic growth cycles,
making them difficult to catch in stool analysis. Depending on the species,
they can produce many offspring. Usually, two or three random samples of
stool are required to increase likelihood of identifying them.
BABESIOSIS
Babesia species are protozoal single-cell parasites transmitted by ticks.
Babesiosis is related to malaria, which is carried by mosquitos. Babesia have
an affinity for red blood cells and are referred to as piroplasms because of
their pear shape within the red blood cell, visible with blood smear tests.
They are one of the most prevalent blood parasites in the world, initially
identified by Romanian scientist Victor Babes in 1888, when several cattle
were infected.
Ixodes ticks are the only ones known to carry babesiosis. There have been
more than one hundred Babesia species identified, with only a small percent-
age of those causing illness in humans. Studies have shown that 40–60
percent of white-footed mice are infected with B. microti, which infects ticks
in the nymph stage. 36 However, birds and rodents alike can be reservoirs for
the infection. B. duncani WA-1 was first identified in patients in Washington
State, so many practitioners feel that it is a West Coast disease; but I see a
large number of positive tests in New England in patients who have never
been out West. 37
Because of Babesia’s parasitic relationship with red blood cells, the cells’
ability to carry oxygen and retrieve cellular wastes is negatively affected. Red
blood cells are often discarded by the body and sent to the spleen, which leads
to swelling and pain in this organ, along the lower left side of the rib cage.
This infection can be very serious for those without a spleen because there is
no other way for the infected blood cells to be purified and the spleen serves
an important role in immunity.
Many of the symptoms of babesiosis occur because of oxygen deprivation at
a cellular level. For example, the low level of oxygen can create anxiety, as if
you were holding your breath under water. Once the oxygen starts to run out,
you start to feel increased anxiety, prompting you to break through the surface
of water for air. Babesiosis patients are usually very oxygen depleted, making
them bedbound. Just doing the dishes is exhausting. They will be winded from
taking a shower, requiring a nap afterward. Or they may be too tired to shower,
which leads to poor self-care and hygiene, purely from lack of energy.
In 2018, the U.S. Food and Drug Administration approved testing of blood,
organ, and tissue donations nationwide for B. microti using the Imugen
Arrayed Fluorescent Immunoassay (AFIA) and Nucleic Acid Test (NAT) in
whole blood samples. 38 This will most certainly reduce the transmission of this
blood-borne pathogen in the blood supply, which in many cases goes to those
who are already immunocompromised.
Symptoms: Symptoms can vary, depending on the immune system’s
response. The Centers for Disease Control refer to babesiosis as a self-limiting
disease, meaning it will resolve on its own. I don’t usually see that happen.
A patient will typically have persistent headaches, debilitating fatigue,
fevers, chills, sweats, dizziness, enlarged spleen, elevated eosinophils in tissue
(which create swelling and allergic-like reactions), petechial rashes (which
look like broken blood vessels in the skin), shortness of breath, easy bruising,
bone pain, numbness and tingling, abdominal pain, fibromyalgia, nausea,
anemia, blood in the urine, and anxiety/depression. Full-body spasmodic
episodes that resemble a seizure, occurring daily or a few times per week, may
also be a symptom. Patients experience real difficulty multitasking and
become overstimulated in public places.
Treatment options: Pharmaceutical medications— atovaquone (Mepron),
atovaquone/proguanil (Malarone), artemether/lumefantrine (Coartem),
hydroxychloroquine (Plaquenil), quinine (Qualaquin). Intravenous medication
is clindamycin. Treatment duration is usually at least 120 days, which is the
life expectancy of the red blood cell.
Natural treatments—Artemisia, Coptis, Sida acuta, oregano oil, cryptolepis,
neem, 39 Nyctanthes arbor-tristis Linn.,40 Bupleurum, dandelion, cleavers, blue
flag iris
INFECTION WITH HELMINTHS OR AMOEBAS

A variety of larger parasites find the human body a suitable home. These can
go unnoticed for years because of their unpredictable life cycles and the body’s
ability to adapt to their presence. Helminths are flatworms and roundworms
that primarily colonize areas of the intestines, though they are not confined to
the intestines. Liver flukes, a type of helminth, can move through the body’s
organ systems and blood, usually finding a home in the liver-gallbladder area.
Several symptoms, including poor liver function, fatigue, and irritable bowel
syndrome, may well be due to a parasite. Many of my patients over the years
have had a spontaneous release of worms in a bowel movement, which was
shocking to the individual, to say the least. Whether the release is triggered by
a medication or a dietary change, or for an unknown reason, the patient’s
overall energy generally improves once the worms have been eliminated.
Amoebas are smaller pathogens that colonize the digestive tract, causing
mild to severe digestive problems, including dehydration, relapsing diarrhea,
gas/bloating, undigested food in stool, and high levels of mucus or blood in the
stool. Once in the body, amoebas can stay there for years, slowly growing and
shedding at irregular times. Stool analysis can be helpful, but usually more
than one sample is necessary to confirm the presence of amoebas; even that
does not always work. Amoebas are most commonly transmitted when
humans ingest undercooked meats or water tainted with fecal matter or
through human-to-human or animal-to-human contact. They are more
commonly encountered with international travel but are present in the U.S.
water and food supply as well.
Amebiasis and helminth infections are important to mention because of
the stress they place on the body by causing malnourishment, increased
symptoms associated with autoimmune diseases, allergic reactions, chronic
fatigue, changes in organ function, inflammatory bowel disease, and
destruction of the gut microbiome, depending on where the infection takes up
residence. Infection by these parasites can be a missed complication in a
patient who is unable to tolerate medications and has a history of digestive
distress. Also, it’s not uncommon to have a release of worms or liver flukes
while undergoing treatment for tick-borne disease, which can be very
distressing to the patient. Several medications used to treat the cyst form of
the Lyme disease bacteria are the same as those used to treat worms and
parasitic infections.
Symptoms: Most of the symptoms have to do with digestive function,
including inflammation of the gastrointestinal lining as the immune system
recognizes something that does not belong. As with any parasite, helminths
and amoebas feed off the resources of the host, so the infected patient usually
experiences weight loss, diarrhea, constipation, bloating, and/or abdominal
pain. They may also have stools with mucus, visible blood, or undigested food.
Nutrient deficiencies may occur, such as low iron due to poor absorption.
Rashes on the skin that come and go as well as itching of the skin are also
signs of digestive tract inflammation.
Treatment options: Pharmaceutical medications—Tindamax/Flagyl,
Alinia, ivermectin
Natural treatments—black walnut, Artemisia annua (wormwood), neem,
oregano oil, grapefruit seed extract
In Summary
Evaluation and treatment of coinfections are important for a successful recovery.
We have all acquired infections as part of our human experience. The microbial
world is a highly diverse realm, and understanding this reduces the chance of
developing tunnel vision and focusing on one infection. Between infections that
come in with the tick and opportunistic infections already present in your
system, your treatment may require a diverse array of medications.
The following chapters will review testing and treatment options to help
you advocate for yourself as you move toward recovery.
CHAPTER 4
FINDING
THE MOST
ACCURATE
TESTING
pervasive belief is that if the lab result for Lyme disease is negative,
A the person must not be infected; however, this is not necessarily so.
If your lab result is positive, you have been exposed to the infection;
if your lab result is negative, it does not mean you don’t have Lyme
disease. It’s common to experience anxiety and indecisiveness after a negative
test, when your primary care provider and the Centers for Disease Control are
both saying you don’t have Lyme disease and only a small group of practitioners
across the country is saying you do. It’s very difficult to decide to move forward
with treatment when there is so much disagreement in the medical field.
Many people are living with Lyme disease and don’t know it. They have
pain and fatigue but think this is a normal aspect of daily life. How many times
do we see commercials promoting pain relievers on TV that make pain look
normal? Functional Lyme patients are those who have positive titers and history
but who have no symptoms. This is more common than you think, and it is why
I suggest being tested for Lyme disease yearly if you live in an endemic area. It’s
just like getting your cholesterol checked. You may not know you were bitten
and may not show strong symptoms. It’s important to know if you have been
76
exposed so that if your health changes, you can
explore Lyme disease as a potential cause.
Many patients who have symptoms but test
Many people
negative for Lyme disease decide not to treat because are living with
they want proof on paper. As much as doctors and Lyme disease
patients would like concrete data, the human body
and don’t know
does not always show conclusive signs on lab work.
A blood test is a snapshot of one moment in time—a
it. They have
small amount of blood vacuumed into a tube at a pain and fatigue
particular minute is asked to represent what is going but think this is
on in the body overall. If you tested the same
a normal aspect
variables throughout the day, many standard tests
would show different outcomes. I was taught in
of daily life.
medical school that taking a detailed history tells you
about 90 percent of what you need to know to make a possible diagnoses, with
labs attempting to confirm a concrete diagnosis. If a patient was bitten by a
tick and has not felt well since, the cause is pretty clear. The matter becomes
more confusing when the patient has no memory of a tick bite.
Confirming Lyme Disease:

ELISA and the Western Blot
The Centers for Disease Control and Prevention (CDC) mandate that the
enzyme-linked immunosorbent assay (ELISA) or the C6 antibody screen be
run first. These are screening tests, rather than confirmatory ones, and are
supposed to be very sensitive, picking up the slightest hint of rising antibodies
due to exposure to Borrelia burgdorferi. The idea of running these first is to
make testing cost effective and to add more data for a firmer diagnosis of Lyme
disease. The Western blot is meant to have high specificity for Lyme disease
and is the confirmatory test, run only if the ELISA or C6 ELISA is positive.
Unfortunately, the ELISA is not the sensitive test it’s purported to be. I
have witnessed many false negatives. The common two-tiered testing only
looks at one strain of Borrelia, though there are more than forty identified
strains across the globe, with several specific to the United States. Specialty
labs such as IGeneX have a Western blot that takes a more specific look at
multiple strains, to give a more diverse view.
Titers (a measure of the presence and number of antibodies in the blood)
for infections will vary based on the person’s immune status, the stage of
77
infection, and hormone balance. The ELISA and Western blot look at the
immune cells produced by the host rather than at the pathogen itself. This
method is referred to as indirect testing. If you were to look at a lab report for
the Western blot, you would see IgM and IgG immunoglobulins produced by
the patient’s immune system. These are antibodies, proteins produced as a
reaction to an infection. Antibodies are categorized based on an atomic weight
classification called kilodaltons (kDa), with each being given a specific number
such as 41 kDa, 23 kDa, or 39 kDa. The bands on the Western blot test repre-
sent proteins present when the body comes into contact with B. burgdorferi or
with parts of the spirochete. For instance, band 39 kDa is specific to the
flagella, or tail, of a Lyme disease spirochete. The presence of band 39 kDa is
thus indicative of a current infection.
IgM bands are associated with a new, acute infection, or sub-acute active
infection, while IgG bands are associated with more long-term, active chronic
infections or with antibodies that persist after the infection is resolved. The
CDC considers an IgM test positive if two out of three bands are positive; the
three bands are 23 kDa, 39 kDa, and 41 kDa. At one time, more bands were
required for positive confirmation of an IgM test; the number was slimmed
down to just three bands several years ago. For a positive result to be acknowl-
edged for IgG, five bands must be positive out of a possible ten.
As I noted earlier, the Western blot run through conventional labs such as
LabCorp or Quest Diagnostics is the confirming test most frequently used. This
is partly due to patient preference regarding cost, based on what most insurance
will cover. Some patients seek me out specifically to run tests at specialty labs
such as IGeneX because they have conducted their own research online and their
doctor refuses to run the tests. Many in the medical community believe that the
Western blot run at IGeneX labs all come back positive, so the lab must be
useless. Many patients have reported that their medical practitioners refuse to
even look at their results, saying immediately that the report is inaccurate. After
using IGeneX for more than a decade, I can say from experience that this is not
true. Many tests return with a negative result, showing no exposure to infection.
When a pregnant woman who has Lyme disease gives birth, the Western
blot can be run on the newborn’s cord blood. Cord blood is extracted at the
time of birth, requiring that a kit be ordered ahead of time, signed off on by the
ordering doctor, and taken to the hospital before the date of delivery. This has
been really helpful in putting parents’ minds at ease about the possibility of
transmitting tick-borne infections within the mother to the baby.
I treat empirically based on tick bite history and symptom presentation,
informing the patient that we will treat without lab confirmation to see
whether there is any change in her health. Remember, there are many strains
of Borrelia, and every test has its limitations. With the funding constraints for
research devoted to this epidemic, we are still at the tip of the iceberg with
regard to understanding how to best test for this microbe.
Less Common Tests

While the two-tiered testing of ELISA and the Western blot is most common,
other testing methods are available. The polymerase chain reaction (PCR) and
culture tests blood, cerebrospinal fluid, biopsied tissue, and fluid pulled from
joint spaces. PCR is able to identify and amplify DNA of the microbe within a
sample, confirming infection within the body. These testing options are ideal
for confirming some infections but are not the most efficient for B. burgdorferi
because of the PCR’s low sensitivity and the difficulty of growing Lyme
disease in a culture medium that can be used in a routine clinical setting. It
can take anywhere from several weeks to several months to grow spirochetes,
due to their replication timing and the fact that they require a very specific
environment. The most practical approach is to run blood samples for Western
blot initially and to use the PCR and/or culture as second-tier testing.
Another testing option is the dot blot, which is similar to the Western blot
but has subtle differences in the specimen type and test procedure. This test
requires the patient to take antibiotics and/or natural medications for a period
of time to stimulate the release of bacterial debris in the urine. I have not used
this test very often in practice, though I know many doctors who use it as their
primary testing option. It can be helpful when confirmation is needed for
specific treatments or if the patient is not willing or able to give blood.
However, cross-reactions with other urinary infections can occur, and other
tests should be run to support the diagnosis.
Urine testing using nanoparticles to measure OSP-A proteins created by B.
burgdorferi is a new option just emerging on the market.
A Balanced Approach
to Testing
Lab tests help you understand your internal world and can be life-saving in
many cases. It’s important to have your lab results reviewed by a doctor who
can help you interpret them. In recent years, there has been a lot more freedom
surrounding medical testing, with people ordering labs for themselves and
F I N D I N G T H E M O S T AC C U R AT E T E S T I N G 79
Freak Them Out: Exercise
and Natural Medications
Can Force Spirochetes into
Circulation
BORRELIA SPIROCHETES HAVE MANY MECHANISMS in place that allow
them to hide from the human immune system, including protection within
biofilms, enhanced motility, and dormancy. Before your blood test to check for
Lyme disease, try to tease the spirochetes out so the outcome is more apt to
be accurate.
Researchers are starting to consider the use of stevia and serrapeptase to
enhance PCR testing outcomes because these substances can stimulate the
release of more spirochetes in the bloodstream.1 I suggest taking these supple-
ments one to two weeks before testing to allow the body time to develop any
immune reaction.
This not only makes the spirochetes’ DNA more bioavailable for PCR testing,
but also could improve indirect testing with the Western blot by enhancing IgM
and IgG antibodies. Blending both internal biofilm agitators as well as deep
tissue massage, different forms of exercise, sauna, or Qigong might also improve
the test outcome. This strategy is worth trying if you present with all the
symptoms of Lyme disease but have had no confirmation on lab tests.
receiving results before doctors do; but this can lead to confusion. If you start
researching on the Internet, you may misinterpret some findings, which leads
to fear. This fear can lead you to make assumptions about what you are looking
at and possibly cause you to self-diagnose inaccurately.
Approach testing with moderation. Patients often come in asking for “the
works,” based on their own research or recommendations made by other
doctors. When I tell them the cost (thousands of dollars in out-of-pocket
expenses) and how many sittings (two or three appointments) it will take to
get the amount of blood needed, their list shortens quickly. I can test for
everything under the sun, but to what end? In the past, I have agreed to run
everything the patient wanted. Thousands of dollars in out-of-pocket
expenses later, there was no change to the treatment plan that had been based
on the simpler testing approach. Then, there is the other extreme, where
patients report that some practitioners are unwilling to run even those tests
covered under insurance to screen for tick-borne disease.
Most insurance, I find, will cover tests with mainstream laboratories for
tick-borne infections, viral titers, and hormone panels. There are specialty
labs that use more sensitive testing for tick-borne infections, inflammation
markers, heavy metals, and hormones; and these represent out-of-pocket
costs. These tests are run when the situation requires definitive information
needed for a more specific diagnosis. I may ask the patient to send out to
IGeneX or Galaxy labs to have a more sensitive test performed for Bartonella
infection if other tests are inconclusive and there is concern about initiating
treatment without more information. However, additional testing must always
be balanced against the costs; specialty testing can be expensive, and much of
it is not covered by insurance.
Routine versus
Specialized Testing
I’ll discuss first the tests run for the majority of patients; then I’ll review those
tests run on a case-by-case basis. Most lab results are reevaluated in two- to
six-month intervals.
When a patient comes to the clinic concerned about having chronic
tick-borne disease, the tests I usually order are Lyme disease Western blot,
Babesia, Bartonella, ehrlichiosis, anaplasmosis, Rocky Mountain spotted fever,
Q fever, Mycoplasma pneumonia, brucellosis, strep antibodies, CD-57/CD8+,
chronic viral infections, Candida albicans, hormones, inflammation, complete
blood cell count, comprehensive metabolic panel, vitamin status, and autoim-
mune markers.
Specialized lab tests, which are run on a case-by-case basis, are heavy
metal testing; salivary adrenal function testing; stool analysis; nasal culture;
test for Ritchie Shoemaker, M.D., biotoxin markers; neurotransmitter testing;
tests for food sensitivities; chronic strep infection antibodies; omega fatty acid
levels; lipid panel; and Boston Heart Lab.
There are many additional lab tests that might be ordered based on an
individual’s case, and these are decided by the treating physician. This section
provides you with a general understanding of available tests so you can help
your doctor in identifying the source of your ill health.
Lab tests are useful in getting objective data, but no test is perfect. As I
noted earlier, these tests provide a snapshot of the moment the blood was
The Short Life of the Lyme
Disease Vaccine
LYMERIX, THE FIRST AND ONLY LYME DISEASE VACCINE for humans, was
approved by the FDA in 1998. It was introduced by GlaxoSmithKline in regions
infested with infected ticks and had a very brief life before being withdrawn
from the market in 2001. Negative publicity began to swell when a number of
patients reported developing Lyme disease–like symptoms after the vaccine was
administered. News outlets started to report that the vaccine was harmful.
By the time research was released explaining that the vaccine was not
harmful, it had been pulled from the market due to low sales. The vaccine was
rejected by the public at a time when Lyme disease was not as big a concern as
it is now. The negative reaction to the vaccine was ultimately found to be
confined to a subset of the population with the genetic marker HLA-B27, which
is associated with autoimmune disease.
Those people who received the vaccine but did not have the genetic marker
were tracked for years after being vaccinated and had very low infection rates
for Lyme disease. I also believe that many of those vaccinated may have had
Lyme disease without knowing it. Being given the vaccine upregulated their
immune systems, thus creating a Herxheimer reaction.
A few years after the vaccine was no longer available, the CDC modified the
Western blot by removing bands 31 kDa and 34 kDa, which would create a false
positive if the person tested had received the vaccination. This is why many people
choose to use specialty labs that have this additional information as part of the
test. To date, out of the four thousand patients I have treated over the years, I have
only met two who had the vaccine. I have always wondered how many people get
false negative results now because of this change to the Western blot, which was
intended to avoid a very small population of false positives.
taken, and many of the tests will vary in outcome and have different reference
ranges provided from different companies for the same test. Also, these ranges
change often, based on evolving research. Whereas most tests are automated,
some are still being read by humans. The interpretation of the outcome will
vary subtly depending on who is doing the reading.
Different doctors also have varying styles, and some prefer to work with
certain companies. Doctors also have their own routines and reference ranges
they see as optimal. All of these variables can take an objective piece of data
and make it quite subjective. This is why lab tests are an amazing set of data,
but it’s best to be discerning about the outcome.
Common Lab Tests
TESTING IS A SOURCE OF FINANCIAL CONCERN for patients who are trying to
get answers without emptying their bank accounts. Lab tests can be a major
expense when treating tick-borne disease. The lists below give a rundown of (1)
lab tests commonly covered by insurance and (2) specialty tests typically not
covered, as they are considered experimental. Many other options for testing
exist, but the full complement of tests available is beyond the scope of this book.
Note: Coverage may not be possible for any lab tests, depending on the
individual insurance plan and deductible.
ROUTINE LAB TESTS COMMONLY COVERED BY INSURANCE
Coinfection Panel
• Babesia microti, Babesia duncani, Bartonella henslae, ehrlichiosis, anaplasmosis,
Mycoplasma pneumonia, brucellosis, strep antibodies, Rocky Mountain spotted
fever
Viral Titer Panel
• Epstein-Barr, parvovirus B19, cytomegalovirus, herpes simplex virus I/II,
varicella zoster and human herpesvirus 6
• CD-57/CD8+
Male/Female Hormone Panel
• Estrogens, progesterone, testosterone, dehydroepiandrosterone (DHEA)
Thyroid Hormone Panel
• TSH, free T3, free T4, thyroid antibodies, reverse T3
Inflammation/Autoimmune Panel
• Rheumatoid factor, C-reactive protein, sedimentation rate, CCP antibodies,
antinuclear antibodies, and Sjögren’s antibodies
Complete Blood Cell Count and Comprehensive Metabolic Panel
Vitamin and Mineral Status
• Vitamin D, vitamin B12, vitamin B6, folate, copper, zinc, magnesium (there is
specialty testing for a more comprehensive vitamin analysis)
Candida Antibodies IgM, IgG, IgA
HLA-DR Genetic Panels (Mold-illness, Gluten Intolerance)
Total Immunoglobulin Levels (IgG Subclass, IgM, IgE, IgA)
Gluten Intolerance Testing (Celiac disease)
• Tissue Transglutaminase IgA, IgG (tTG)
• Endomysial Antibodies
• Anti-Gliadin Antibodies
SPECIALTY LAB TESTS
• Adrenal Salivary Index • Heavy Metal Testing • Nasal Culture
• Neurotransmitter Panels • Stool Analysis • Small Intestinal Bacterial
• Food Sensitivity Panels • Genetic Testing Overgrowth (SIBO)
The Information Your
Body Can Provide
Lab tests can provide objective data that give a more concrete treatment path
to follow. The information below provides a deeper understanding of the
common tests run and how they measure human health. These tests allow
medical providers to individualize care and create a more specific treatment
plan, better serving their patients.
C D - 57 T E S T
The CD-57/CD8+ marker (CD stands for “cluster designation”) is used to track
a patient’s progress through treatment. The CD-57 belongs to a specific
immune cell line called a natural killer cell. The natural killer cell responds
directly to antigens—either toxins or infection—entering the body. Natural
killer cells take care of these foreign substances introduced into the body
without you even knowing it. They even continuously eliminate precancerous
cells, as they recognize these cells are not compatible with maintaining
optimal health. Several different CD cells exist, and each has a specific affinity
for a type of foreign invader.
The test for CD-57 is not diagnostic for Lyme disease as is the Western
blot, but monitoring this marker’s levels throughout a patient’s treatment
process helps evaluate the individual’s response to treatment. I use this test to
track the activity of these cells, taking the patient’s original number and
following it like an infant growth chart. This test is repeated every three to six
months and used as another piece of data to track a patient’s response to
treatment. The test can also indicate if a patient is having a relapse.
Published research, primarily by Raphael Stricker, M.D., has shown a
correlation between lower CD-57 levels and potential risk of relapse in chronic
Lyme disease.2 Further studies have also shown a strong correlation between
an abnormal CD-57, usually decreased, and the several autoimmune diseases. 3
The reference range is 60–360 cells per microliter of blood. Most chronic
Lyme disease patients are below 60 cells per microliter of blood. A level lower
than 100 is undesirable, and the goal is to have this immune cell living in
healthy numbers of around 200–360 in the human body.
It’s important, however, to remember that this is simply a marker and not
to get attached to it. Over the years, I have seen in my patients a correlation
between CD-57 and chronic Lyme disease, with lower numbers also in those
with reactivated Epstein-Barr virus and coinfection with Babesia species. Try
not to become preoccupied with the CD-57 result if the number is less than
you were hoping for. For some people, it takes longer for this number to return
to normal than it does for others. What matters most is how you feel.
M A L E / F E M A L E H O R M O N E PA N E L S
Hormones play an important role in immune function, support of proper
growth and development, and healthy energy levels. When persistent infec-
tions exist, glandular function can decrease, there may be poor communication
between the brain and glands, and changes in hormone balance can occur in
both genders. This seems to happen to people in just about every age category,
affecting energy level, libido, sleep cycles, mood, cognition, and healthy
biological functions. Nearly all my patients have some form of hormone
imbalance. This test can also be used to make sure bioidentical hormone doses
are healthy and in balance. Treatment can be easily modified with the support
of testing to optimize the dosage for the patient’s individual needs.
T H Y R O I D H O R M O N E PA N E L
The thyroid is one of the glands of survival, managing the body’s metabolism in
times of health and when the body is under stress. Tick-borne diseases, dietary
sensitivities, and toxins can change the function of the thyroid gland, leading
to either overproduction or underproduction of thyroid hormones. It’s common
for the immune system to attack the thyroid, creating antibodies that heighten
or lower the function of the thyroid. This can happen because of genetic
predisposition, infections, toxins, or food intolerances such as celiac disease.
To get an overall view of thyroid health, I recommend testing the thyroid
hormones T3 and T4 as well as the thyroid antibodies. To test the health
of the thyroid, physicians usually run a test that checks the levels of thyroid-
stimulating hormone (TSH). This is the hormone the brain secretes to
communicate with the thyroid, allowing it to maintain proper function.
Testing all these parameters—T3, T4, antibodies, and TSH—is necessary to
assess hormone function and devise the most effective treatment, if needed.
Treatment of imbalance is usually herbal medication or bioidentical
hormone replacement therapy. Symptoms of low-functioning thyroid are
weight gain, constipation, and changes in hair, skin, and nails. Elevated blood
pressure or low blood pressure can also be present. In my practice, I see more
low-functioning thyroid than hyperfunctioning thyroid. Reduced thyroid
function is due to autoimmune attack of the thyroid or low hormone output
due to the gland being overwhelmed by prolonged illness in the body.
Some patients have had the thyroid removed or the gland killed with
radioactive iodine to stop overproduction of thyroid hormones. Those
without thyroid function are treated as hypothyroid patients and prescribed
thyroid medication. If a problem with the thyroid exists, there is almost
certainly a problem with its partner, the adrenal
glands. Iodine blood levels may be checked if
Lyme disease, low-functioning thyroid occurs without signs of
because it can autoantibody attack. Iodine is a nutrient require-
move into body ment for proper thyroid function.
spaces such as
I N F L A M M AT I O N /AU TO I M M U N E
joint capsules, PA N E L
muscles, organs, The autoimmune panel expands my differential
and tissue, can diagnosis (the process of differentiating between
conditions that share similar symptoms) to rule out
be a catalyst for
the presence of lupus, Sjögren’s syndrome, rheuma-
developing an toid arthritis, juvenile rheumatoid arthritis, mixed
autoimmune connective tissue diseases, and others. Lyme disease,
disease. because it can move into body spaces such as joint
capsules, muscles, organs, and tissue, can be a
catalyst for developing an autoimmune disease. Both can happen at the same
time. A patient may require care from a rheumatologist to provide necessary
medications to find relief of symptoms. I always encourage patients to seek
second opinions and work with other specialists as needed.
An additional test that is important for those who experience persistent
joint pain despite treatment for Lyme disease detects the presence of the
human leukocyte antigen B27 (HLA-B27) marker on white blood cells. This
specific HLA on your white blood cells can cause your immune system to
attack itself under certain stressful conditions. Immune cells with this
particular marker are implicated in attacking connective tissue in the body,
and these cells have been linked to reactive arthritis when triggered by an
event such as a microbe entering the body. Those who have this marker also
have a higher likelihood of developing ankylosing spondylitis, which causes
inflammation of the bones in the spine.
CO M P L E T E B LO O D C E L L (C B C ) CO U N T A N D
CO M P R E H E N S I V E M E TA B O L I C PA N E L
These are standard blood tests used by every medical practice in the world.
This panel gives a general overview of the health of the immune system, the
kidneys, and the liver, as well as electrolyte levels. The tests provide useful
information for monitoring the body throughout the treatment process for
Lyme disease to make sure no unwanted side effects from medications occur
and that there is no trauma to the organs for other reasons. The most
common abnormalities I see are slightly elevated liver enzymes and anemia.
Among my patients, it is rare for these tests to come back showing severe
complications. The CBC and metabolic panel are always helpful for a patient
who is uncomfortable about the use of antibiotic or other medications—seeing
on paper that their health is not adversely affected by the treatment means
they have one less concern.
V I TA M I N A N D M I N E R A L S TAT U S R E P O R T
Vitamin and mineral levels commonly tested are iron (including ferritin
levels), vitamin D, B12, folate, B6, zinc, magnesium, and copper. These can all
be depleted with long-term illness, poor digestive health, and long-term use of
antacids (which most patients have been prescribed prior to presenting to the
clinic). Nutrient deficiency can contribute to adrenal fatigue, anxiety, depres-
sion, muscle cramps, cardiovascular instability, enhanced metabolic risk
factors, and poor concentration.
Vitamin and mineral levels are easily tested through conventional labs
such as LabCorp or Quest Diagnostics, which makes insurance coverage more
likely; but micronutrient testing available from companies such as SpectraCell
Laboratories offers a more in-depth look at your current vitamin status and
immune function. Micronutrient panels such as those offered by SpectraCell
are typically not covered by insurance. They are valuable in providing a
snapshot of your current vitamin, amino acid, and mineral status but do
represent an out-of-pocket expense. Looking at nutrient deficiencies can help
you give your body exactly what you need for optimal health.
Vitamin D is discussed in further detail in chapter 8. This essential vitamin
is typically low in most of my patients unless they are already supplementing it
on their own. The optimal level for this vitamin and hormone is 60–70 ng/ml,
whereas most Lyme disease patients have very low levels, below 30 ng/ml.
T E S T FO R C A N D I DA A N T I B O D I E S
Whether or not a patient reports symptoms associated with yeast overgrowth,
such as skin rashes, nail bed infections, sugar cravings, oral lesions, digestive
complaints, or vaginal irritation with discharge, I test routinely for Candida
antibodies. If the body is creating antibodies against Candida albicans, immu-
nity can be reduced and inflammation increased. This can make treatment
more difficult if Candida is not addressed with proper dietary changes and
antifungal medications. Levels of Candida antibodies are monitored routinely
throughout treatment when antimicrobials are used due to the possibility of
yeast overgrowth as a byproduct of treatment. The microbiome requires utmost
support with prebiotics, probiotics, and significantly reduced sugar consump-
tion during the treatment process to avoid overgrowth of unwanted guests
such as nonbeneficial yeast. One way to counter unwanted microbes is with the
therapeutic use of the beneficial yeast culture Saccharomyces boulardii.
H L A - D R G E N E T I C PA N E L
The HLA-DR genetic panel requires a decoder, known as the Rosetta Stone,
developed by Dr. Shoemaker. The test looks at different codes that represent gene
pathways that enhance a person’s sensitivities to mold biotoxin. I will not go into
great depth about the tests and will instead refer you to www.survivingmold.com,
which provides resources for those suffering ill effects from mold exposure.
The lab values from this test show the level of inflammation and hormone
imbalance in the body, a possible result of the internal environment accumu-
lating too many toxins from microbes. Many patients commonly live or work
in environments that harbor toxic mold due to water damage. This can
compound the symptoms of chronic Lyme disease, making it more difficult for
the person to function. Dr. Shoemaker’s approach addresses the inflammatory
stress that comes from chronic Lyme disease, as well as from mold toxins and
resistant infections of the sinus cavity.
Those who are positive for the genetic markers on this test have a reduced
capacity to clear the mold toxins from the body; these toxins can create brain
fog, fatigue, body pain, neurological dysfunction, nausea, headaches, visual
disturbances, rashes, breathing difficulty, and mood changes.
Treatment is centered on releasing the toxins through specific medications,
making changes in the environment to improve air quality, and enhancing the
immune system. Symptoms of toxic mold exposure are similar to those com-
monly seen in chronic Lyme disease. In fact, there is a genetic pattern tested
within the HLA-DR panel for individuals who have reduced capacity to clear
the toxins created by Borrelia burgdorferi. Based on the outcome of the genetic
testing, the following tests may be done as a further study of body burden:
• Melanocyte-stimulating hormone, C4a, C3a, TGF`-1, VEGF,

anti-cardiolipins, antidiuretic hormones, matrix metallopeptidase 9
(MMP-9), and leptin. These are all components that, when put
together, can raise the stress on the system from biotoxin overload.
Seek out a medical practitioner familiar with Dr. Shoemaker’s
approach to get the best interpretation of these tests.
• Visual Contrast Sensitivity APTitude Test: This test is available at
www.survivingmold.com. I frequently suggest that patients
conduct this test; it is reasonably priced and very helpful in
determining biotoxin body burden and the impact of biotoxins on
the nervous system. The result can be tracked over time to assess
treatment progress.
For further information on mold toxins, testing, and treatment, I recom-

mend Surviving Mold by Dr. Ritchie Shoemaker.
I M M U N O G LO B U L I N L E V E L S
Immunoglobulins are also known as antibodies, which are created by plasma
cells. Looking for antibodies is the most common method to confirm infec-
tions in the body, including Lyme disease (with the Western blot). Antibodies
can be categorized into classes IgA, IgD, IgE, IgG, and IgM. The primary
immunoglobulins tested are IgA, IgE, IgM, and IgG. Each has a specific
purpose in the body. IgE is most present at times of immediate allergic
reaction, such as a person’s allergic response to peanuts or bee stings. In the
context of Lyme disease treatment, the focus is primarily on IgM and IgG.
IgM immunoglobulin is usually the first marker to show in a new infection.
With Lyme disease, IgM can keep upregulating over and over like a brand-
new infection as the spirochetes reproduce, triggering the immune system to
react as if it’s seeing the infection for the first time.
IgG subclass testing is an important panel to perform routinely. The most
prolific antibody that shows up in later-stage infection, IgG maintains human
immunity throughout the whole body from birth. Lyme disease patients can
have a deficiency in this immunoglobulin, which makes it difficult for the body
to mount an appropriate response to clear the infection.
Low IgG also correlates with inflammatory conditions that cause nerve
damage, such as Guillain-Barré and chronic inflammatory demyelinating
polyneuropathy (CIDP); this damage can be confirmed with a biopsy of tissue
taken from the affected area.
The treatment for the condition is called intravenous immunoglobulin
therapy (IVIg) and involves replacing the immunoglobulin IgG. It’s currently
not approved for use with Lyme disease, but clinically there is a correlation
between those with rapidly progressive neurological decline and low IgG
levels. If this level is low in a Lyme disease patient, the next step is to see a
neurologist or immunologist to evaluate for IVIg treatment. It takes hundreds
of donors to yield just one dose, and the price per dose is several thousand
dollars. This treatment is very difficult to get covered by insurance, but I have
seen it really improve a patient’s quality of life and ability to fight infections.
G L U T E N I N TO L E R A N C E T E S T I N G
This test is done to rule out celiac disease or gluten intolerance. Unfortunately,
if a person had a slight intolerance to gluten before contracting Lyme disease,
that intolerance will magnify in a majority of patients. Stress on the immune
system can prompt an improper immune response to foods. With gluten
sensitivity or celiac disease, an overabundance of autoimmune antibodies
created in response to gluten exposure leads to inflammation in the body,
negatively impacting cognition, skin, respiratory health, thyroid balance, and
energy levels; the condition creates body pain as well. Gluten proteins can also
wear away the lining of the gut, making it difficult to absorb proper nutrition.
Gluten intolerance is a gray area and may not show up positive on lab
results, as celiac disease does. Most Lyme disease patients should reduce or
eliminate gluten as part of their treatment process, to reduce inflammation in
the body. This will also significantly reduce the intake of sugar, which has its
own health implications. Many patients on gluten-free diets show improve-
ments in symptoms that have been present most of their lives, such as digestive
imbalance, postnasal drip, unwanted weight, and acne.
This is one of those tests that, if positive, means you really need to remove
gluten, but if negative, it is still worth trying a 30-day restriction period to see
whether it makes a difference in your health. However, most people want to
see the need on paper before ditching one of their favorite food categories. The
most common way to determine a diagnosis of celiac disease is through tests
for tissue transglutaminase, endomysial antibodies, and gliadin antibodies.
Specialty Testing
Each medical specialty has its own way of using laboratory medicine to
diagnose illness. There are tests that are standard across all specialties, and
then there are those tests that look in greater depth at more specific data. In
the naturopathic medical community, we use lab tests to look at detox
pathways, gauge food intolerance, assess toxic burden in the body caused by
heavy metals, evaluate hormones, and analyze stool analysis to expand on
possible causes for digestive distress. Whether you are seeing a naturopathic
doctor for Lyme disease or for another reason, these common tests are used in
the naturopathic medical community to craft an individualized treatment
plan. Because many of these tests are not embraced by the allopathic medical
community, they may not be covered by insurance. The good news is that
many of the tests are reasonably priced for most patients.
A D R E N A L S A L I VA RY I N D E X
The adrenal glands sit atop the kidneys and play several roles in the body,
including balancing blood sugar, helping the body adapt to stress, maintaining
a proper sleep schedule, and regulating the immune system. When the adrenal
glands are not functioning properly, quality of life can be compromised. The
preferred test measures hormone levels in saliva, the best method for measur-
ing free, active levels (adrenal hormones are either inactive—bound to a
protein—or active—freely roaming).
One of the most important components of the test is the graph of cortisol
output, which shows the trend of this hormone from early morning to before
bed. This requires four collections of saliva through the day at specific
intervals. Cortisol is expressed as a response to adrenaline output; it smooths
out physical, mental, and emotional responses to stress and helps in recovery.
Over time, if adrenaline production is constantly being stimulated by trauma,
anxiety, unusual physical demands, or pain, energy reserves will decrease,
leading to poor recovery and physical health.
Cortisol is at its peak in the morning, to get you out of bed, and then it
gradually reduces throughout the day so you are ready for bed in the late
evening. Many Lyme disease patients have cortisol levels that are either flat or
have the curves reversed, with the lowest levels produced in the morning
hours and higher levels at night. This creates an altered sleep schedule, so you
are up late at night and sleep later in the day.
N E U R OT R A N S M I T T E R PA N E L S
Neurotransmitter panels are urinary and salivary hormone panels conducted
to assess the levels of histamine, serotonin, norepinephrine, dopamine,
gamma-aminobutyric acid (GABA), PEA, epinephrine, and glutamate. Proper
balance of these hormones promotes quality sleep, concentration, balanced
mood, and healthy appetite, all of which are altered when the body has
chronic active infections.
If testing shows that neurohormones are out of balance, natural medica-
tions in the form of botanicals and amino acids can work more effectively, in
many cases, than prescription medications. In other cases, prescription
medications may be required but natural medications may help reduce the
amount needed.
F O O D S E N S I T I V I T Y PA N E L S
The increase in genetically modified foods, hormones given to poultry and
livestock, and pesticides used on produce has certainly changed the human
body’s relationship with food. With most common foods, the immune system
should not mount a response that causes chronic infection. If a triggering food is
identified and removed from the diet, dramatic improvements in chronic health
complaints can take place quickly. Food intolerance testing can be very helpful
in providing a clear guide to the foods that trigger your body. The most common
food triggers positive on patient lab results are gluten/gliadin-containing grains,
bovine dairy, eggs, baker’s yeast, and sugarcane. The tests are intuitive to read
and look at more than one hundred different foods.
Typically, allergists test by skin scraping or pinprick testing, where the
allergen is introduced into deeper layers of the skin. Then the skin is observed
for a reaction of redness, swelling, or hives. This method tests a common
immunoglobulin, IgE, which is primarily responsible for the anaphylactic
response. I don’t want to understate the importance of testing for IgE, which
is responsible for acute reactions such as those experienced by people with
severe peanut allergies; knowing about the allergy could mean life or death.
Sensitivities that cause more chronic conditions such as asthma, eczema,
digestive issues, fatigue, brain fog, and postnasal drip are due to elevated IgG
immunoglobulins rather than IgE. Thus, these standard skin tests may not
reveal a chronic food sensitivity. IgG is the most copious immunoglobulin in
the body and is there to fight invaders. With certain immune dysfunction, the
immunoglobulin starts to perceive foods as invaders.
H E AV Y M E TA L T E S T I N G
With the assistance of the provoking agents dimercaptosuccinic acid (DMSA),
ethylenediaminetetraacetic acid (EDTA), 2,3-dimercapto-1-propanesulfonic
acid (DMPS), or glutathione (chelating agents), the body can release metals that
have been retained in tissues for years. After oral ingestion or intravenous
dosing of the chelating agent, urine is collected for eight to twenty-four hours.
The medication binds the metals, pulling them from tissues; the metals are then
quickly eliminated by the body. Metals commonly tested are mercury, arsenic,
lead, nickel, uranium, cadmium, aluminum, and other by-products of industry
that are released into water, leach into food, and are airborne on dust particles.
There is a correlation between heavy metals retained in the body and
reduced energy, which is needed to fully recover from chronic infections.
However, I typically focus on the infection first because the microbes can
replicate and migrate through the body. Metals are stored in tissue, making
them less reactive than the infections floating freely in the blood. Blood tests
run by conventional labs show more recent exposure to metals. Bioaccumula-
tion over time requires a stimulant to release the metals in the body; for the
provocation testing, you will likely have to seek out a complementary and
alternative practitioner.
I can’t stress enough the importance of having this process managed by a
doctor trained in chelation therapy. You need to be monitored for healthy liver
and kidney function as well as for proper nutrient status. Chelation will
remove the minerals you do want as well as the metals you don’t. Do not
attempt to self-treat with DMSA or EDTA ordered online, as you could cause
yourself harm. Chelation medications are usually very well tolerated, and a
trained practitioner will do a proper screening to determine whether you are a
healthy candidate for chelation. Herbs and amino acids can support gentle
metal release, and these are fine to self-prescribe; they include chlorella,
parsley, zeolites, sodium alginate, modified citrus pectin, N-acetyl-cysteine,
vitamin C, glutathione, sauna, and gentle fasts.
S TO O L A N A LYS I S
This is probably one of the most humbling tests for
patients to complete, as it involves collecting a stool
We are learning
specimen. It’s less invasive than colonoscopy as an more about
initial screen of bowel health. Stool analysis testing the power of
can be important in identifying inflammation in the
our choices—
bowels, bacterial imbalance, fungal overgrowth,
decreased pancreatic function, malabsorption, and
through proper
parasitic infections. Samples are usually taken in nutrition, toxin
two- to three-day intervals to try to capture certain reduction, and
parasites that shed at random times.
positive changes
Stool analysis is recommended when the patient
has intense abdominal pain with diarrhea, chronic
in our mental-
constipation, blood in stool, copious mucus in stool, emotional life—
intense odor beyond the usual, and/or rapid weight to de-emphasize
loss. Specialty labs (DiagnosTechs, Genova Labs)
genes that are
provide a more comprehensive analysis, but tests are
typically not covered by insurance.
not in our favor.
GENETIC TESTING
We all want to understand ourselves in a deeper way. Genetic testing with
companies such as AncestryDNA and 23andMe, as well as nutrigenomic
testing, in which genetic and individualized nutrition analysis meet, give us
inside information so we can better understand our lineage and improve our
self-care. Genetic testing can show how you process medications, how to be
more proactive about health issues that run in your family, how you best
detoxify, your optimal nutrition, and what types of medications can be most
effective for you. There is usually a two-tiered approach to genetic testing,
with one lab providing codes in alphanumeric form. These results then need to
be sent to a separate company such as Genetic Genie, Xcode Life, or Strate-
Gene that, for a fee, interprets the results.
Knowledge without proper context can be a hindrance rather than a help.
Sometimes, patients come to me practically in tears because of a genetic test
they believe will determine their story. I caution patients to be careful about
believing that they are doomed by their genes. The intended outcome of
genetic testing is to understand possibilities, which is all they are.
The good news is that there is a field called epigenetics that studies the
body’s ability to turn genes on and off without changing the genetic code. The
human genome may be an iron-clad code, but that does not mean we are
doomed. We are learning more about the power of our choices—through proper
nutrition, toxin reduction, and positive changes in our mental-emotional
life—to de-emphasize genes that are not in our favor. We have the power to
improve our health by seeing ourselves as healthy, improving self-care, and
healing our emotional wounds to improve the story written in our genetic code.
N A SA L C U LT U R E
Nasal culture is helpful in identifying chronic infection of the sinuses, especially
MARCoNS (multiple antibiotic resistant coagulase negative staph) infection
high up in the nasal passages. Chronic sinus infections such as MARCoNS can
lower immunity, and the presence of this and other infections can increase
inflammation in the body, increase biofilm production, lower white blood cell
counts, and create chronic fatigue. Nasal culture is important to do if there are
symptoms of recurrent sinus infections, persistent runny nose, or known mold
exposure, and for those with a history of chronic Lyme disease.
This simple test involves swabbing the nasal passages to collect a sample
and sending it to the lab to see what grows based on your flora. The test
typically used in my office is through the laboratory Microbiology DX, and it’s
relatively inexpensive given the data it provides. If a pathogen grows in
culture, this lab will do a sensitivity test, which shows the most effective
antibiotics to treat the infection. A positive test can also be matched with the
biotoxin markers HLA-DR to get a more well-rounded picture of the body’s
overload of biotoxins, based on the protocol created by Dr. Shoemaker to
identify the impact of MARCoNS on the system. These can also be revisited to
check patient recovery posttreatment.
S M A L L I N T E S T I N A L B AC T E R I A L OV E R G R OW T H
(S I B O) H Y D R O G E N B R E AT H T E S T
SIBO is the presence of higher levels of bacteria normally found in the colon,
which may migrate to the small bowel. This is another disease that was
characterized as psychosomatic until the scientific community gained a
greater understanding of the biodiversity and function of the microbiome.
The digestive tract houses trillions upon trillions of microbes that are
viral, bacterial, and fungal and that create a protective barrier as well as
educate the immune system. However, a particular order must be maintained
because microbes that are beneficial in one area quickly become pathogenic in
another area of the gut. An individual’s microbiota is like a unique fingerprint,
with certain strains of microbes living in specific areas of the small or large
intestine. When microbes migrate they cause a change in population, which
can irritate the digestive tract, triggering irritable bowel symptoms, body
pain, motility issues, leaky gut, fatigue, weight changes, and rashes on the
skin. This condition seems to be found more in women and in those who are
taking acid-blocking medications, have a history of irritable bowel syndrome,
or a history of narcotic use.4
The gold standard for confirming a diagnosis of SIBO involves extracting a
bacterial sample from the jejunum of the small intestine, but this is cost
prohibitive and is also invasive. The most commonly ordered test is the
hydrogen breath test; for this test, breath samples are collected every twenty
minutes over the course of two to three hours, and both hydrogen and
methane gases are tested. The output is measured to determine whether there
is an overpopulation of certain methane-producing bacteria. To get accurate
results, the patient must follow specific instructions to avoid certain foods and
medications several weeks before the test is administered. Treatment is either
with antibiotics such as Xifaxan or with antimicrobial herbal protocols, many
of which are commonly used with tick-borne infection.
In Summary
We all like to see evidence on paper that validates and confirms the cause of
our discomfort. As much as you may want answers, take it step by step when
ordering lab tests, to mitigate out-of-pocket expenses. Don’t get discouraged if
lab results don’t always reflect what you want or how you feel. Don’t view tests
as the be-all and end-all in defining your health. Instead, look at them as
valuable tools to help in diagnosis and treatment.
PAR T
2
FI N D I N G
R E LI E F
CHAPTER 5
STEPPING
INTO YOUR
POWER:
SELF-
ADVOCACY
AND
TREATMENT
o matter their age or background, Lyme disease patients have in
N common their struggle to find a doctor who will treat them appro-
priately as well as their stories of pushing through a system in which
they always seem to be chasing other diagnoses. There is a learn-
ing curve in having a controversial disease. You may never have experienced
discrimination before, but you might in this situation—and it will require that
you grow a thicker skin. Other people do not have to agree with the diagnosis
of Lyme disease, but they need to treat you with compassion and respect. We
know boundaries are being crossed when we start to avoid interactions with
others or feel constricted inside when in someone’s presence. If you can’t tell
your practitioner you are concerned about Lyme disease without him shooting
you down or talking to you disrespectfully, it’s time to find another practitioner.
The ideal attitude from a health care provider who is unconvinced of a
Lyme disease diagnosis should be: “I may not agree with the diagnosis, but I
support your choice. Keep me updated.” Often, the conversation is much more
hostile, and I hear of doctors who have gotten up and walked out when a
patient initiates a conversation about Lyme disease. I mention this not because
I want to throw other doctors under the bus but because the dismissive
97
attitude of many in the medical community has become a significant problem
for patients seeking diagnosis and treatment.
We all deserve to be respected, to be heard, and to feel safe when we enter
into a professional relationship with a physician. This partnership between
doctor and patient should be an open dialogue in which the goal is to find the
best solution for the patient. Being a Lyme-literate doctor demands a particu-
lar skill set, and it’s important that the doctor understand the process of the
disease so she can navigate challenges safely on behalf of the patient, as the
treatment can become difficult for many. It is also critical that the practitioner
understand the politics surrounding Lyme disease and the daily challenges a
Lyme disease patient faces so she can support the patient.
When you test with a specialist who is Lyme literate, you are working with
someone who has experience following chronic tick-borne disease patients over
time and who understands the unique aspects of the recovery process. Such
specialists realize the importance of running a comprehensive panel of tests to
assess your health status and understand how to interpret lab results properly.
Many primary care providers are very much in favor of referring patients to
specialists such as me and are supportive of patients working with a doctor who
has more experience treating the condition. A good working relationship between
practitioners makes recovery more successful for patients and their families.
Too often, however, I have to give emotional support and do damage
control after patients have difficult interactions with other practitioners.
These are doctors who, unfortunately, judge a patient’s condition inaccurately,
quoting the Centers for Disease Control’s current Lyme Disease Treatment
Guidelines. Unfortunately, these providers do not always do this in a kind way,
and patients may require emotional support to understand what took place
with a doctor they have trusted for years.
A great deal of misinformation and miscommunication could be avoided if
medical professionals who resist the idea of chronic Lyme disease would
soften their approach with patients. This does not mean they have to agree
with a diagnosis of chronic Lyme disease, but they should voice their opinions
in a respectful way and be open to the patient’s concerns.
The Best of Both Worlds:

A Balanced Approach to Care
Working with a provider who can balance the use of natural medicine with
conventional medications is essential. A practitioner who is steeped in natural
medications only, such as a skilled herbalist or one
with a certificate in homeopathy, will be knowledge-
able in the use of these therapeutics but won’t have the
Natural medi-
necessary training in pharmacology. Medical doctors cine can make
who have not completed special training in natural the difference
medicine or functional medicine will only feel
in whether a
comfortable with prescription medications. Tick-
borne infections require both.
patient makes
Natural medicine can make the difference in it through
whether a patient makes it through the treatment the treatment.
because these natural approaches can help keep gut
health safe and avoid serious infections such as Clostridium difficile, which
occur when there is inadequate flora in the gastrointestinal tract. There are
also many natural ways to promote healthy detoxification, immune support,
and hormone support throughout the process, reducing treatment time and
side effects. Conventional medications are helpful for many acute and chronic
conditions; however, there is always room to balance the care with natural
medicine and other alternative healing modalities that improve quality of life.
Often, patients treat with conventional medical doctors who have no
training or confidence in the use of natural medicine. These doctors may
instruct patients not to take natural medicines, including probiotics, because
they hold a belief, based on their education, that natural medicine is not
useful. On the flip side, natural medicine practitioners can be convinced that
conventional medications are dangerous, and they can be just as extreme
regarding use of prescription medications.
Patients over the years have reported feeling confused about whom to
listen to. What is the truth? It’s important to be discerning in the practitioners
you see and to find a balanced approach to your care. The ideal is a provider
who can pull from different modalities with an open mind.
Tick-borne disease tends to bring on controversy and debate, fueling
division when the solution is unity. We need all hands on deck to treat what is
already an epidemic and to prepare for what is to come with this emerging
infection. Awareness of chronic Lyme disease will hit a tipping point where
we can no longer argue over its existence and will have no choice except to
face it head-on. There will no longer be time to indulge in debate.
This book represents my own experience, but there are many different
styles and protocols out there. My training started with the International
Lyme and Associated Diseases Society (ILADS) practitioners, but my teachers
are the thousands of patients I have worked with over the years. The best
advice I can give is stay on the middle path. Pull from all modalities that feel
good to you. A cornucopia of options exists, including pharmaceuticals,
S T E P P I N G I N TO YO U R P OW E R : S E L F - A DVO C AC Y A N D T R E AT M E N T 99
natural medications, stem cell treatments, dietary changes, energy-healing
modalities, and physical medicine.
You may be compelled to try treatments that in the past you would have
thought of as wacky. The thought of reading a book by a naturopathic doctor
might never have entered your mind six months ago. Yet you are doing it
because you want to get well as soon as you can. This desire may propel you to
finally quit smoking, make healthy dietary changes, work on your past
traumas, change behaviors that have held you back, or alter your life course in
a way that you could never have imagined otherwise. So, you embrace the
wacky in the hope of returning to normalcy. Remember, though, that many
treatments that are now common practice were at one time laughed at.
Always question whether a path feels right for you. Question what is being
offered, the motivation of the practitioner, and what that practitioner is
charging. Is the practitioner promising what you want to hear, though it may
not be an appropriate guarantee? Be judicious. If the practitioner promises a
cure or tells you you’re a quick fix then asks for a big up-front payment, be
wary. If, on the other hand, you feel that a particular practice is where you
belong for your recovery, follow your instinct. Choosing a treatment solely out
of fear or bouncing from doctor to doctor trying to find a quick fix will exhaust
both you and your wallet.
Finding the Ideal

Medication Regimen
The most common antibiotic prescribed for tick-borne disease in people over
the age of ten is doxycycline (for children under eleven and pregnant women,
penicillin or cephalosporin are the antibiotics of choice). Minocycline is the
next-generation drug after doxycycline. I prefer to prescribe minocycline
because it’s easier on the patient’s digestive system and has reduced sun
sensitivity, a common problem with doxycycline. Minocycline can create
pressure in the head, which usually subsides. Most patients can tolerate the
full dose, but it can also be started at a low dose and increased gradually to
avoid this side effect. Minocycline crosses into the brain, which is preferable
in a drug used to treat an infection that can migrate into the brain.
As we saw earlier, the spirochetes change form, and as this happens a
different medication is required to have an impact on the microbe. The spiral
form is most susceptible to the tetracycline family of medications, while the
L-form is more treatable with cephalosporins and penicillins. The cyst form
requires antiprotozoal medications, such as Flagyl, Tindamax, or Alinia, to
break through the cell wall and treat the infection. This is why patients
working with a Lyme-literate doctor often take more than one antibiotic at a
time. Coinfections, discussed in chapter 3, may also require that another
specific medication be coadministered. Such complex medical scenarios mean
that the conventional medicine protocols currently recommended may not be
long enough or diverse enough to overcome the infection.
There are a lot of divergent opinions on the use of antibiotics. Many
doctors are emphatically in favor of their use, while others insist that antibiot-
ics will just make matters worse by driving the infection deeper into tissues
and creating more resistant strains. One to two weeks of medication might be
enough for some people, while others require longer treatment time. Short-
course antibiotics might reduce symptoms and give the false impression the
infection has cleared, only to resurface weeks or months later. It’s important
to treat each case individually, treating until symptoms are resolved and then
continuing for an additional period of time to avoid relapse.
It’s important to weigh the risks and benefits of antibiotic use. Through
years of clinical experience with long-term antibiotics, I have seen these
medications work to help resolve infections or return quality of life to
people who have struggled with Lyme disease. Antibiotics have changed the
course of many patients’ lives, so I use them when it’s appropriate. Do they
work in every situation? No. Nothing works all the time. The best treatment
protocol is designed around individual needs. It’s also important, when
treating with antibiotics, to support the body with probiotics, prebiotics,
and herbal and nutrient support (discussed in chapter 7) to avoid side
effects and long-term complications.
A common erroneous assumption by the conventional medical community
is that the use of antibiotics for Lyme disease is not effective beyond fourteen
to twenty-eight days. Debate about treatment duration and persistence of
infection forms the chief controversy surrounding Lyme disease. Many
doctors have lost their good standing in the medical community and have had
their licenses suspended or been put under a great deal of scrutiny for treating
outside the confines of the Infectious Diseases Society of America (IDSA)
guidelines outlined in the sidebar “What We Resist, Persists” in this chapter.
Research on Lyme disease treatment has been extremely biased in support of
the guidelines, with few resources devoted to studying outcomes with
long-term antibiotics.
Research conducted in opposition to the IDSA guidelines has focused on
proving that Lyme disease persists in the body beyond the conventional
treatment time in a significant number of patients. The IDSA support for those
suffering from post-treatment Lyme disease syndrome (PTLDS) are lacking in
criteria for addressing persistent body pain, fatigue, and neurological symp-
toms. An article published in the International Journal of Infectious Disease
titled “Development of a Foundation for a Case Definition of Post-treatment
Lyme Disease Syndrome” says, “the stated criteria leave much open to
interpretation. With no standardized approach to capturing the symptoms
and functional impact, clinicians and researchers are left to decide on their
own. It is unknown how often or in what manner these criteria are applied.”1
In one study, published in 2017 in PLoS One, researchers inoculated ten
monkeys using ticks infected with Borrelia burgdorferi. One out of ten of these
monkeys developed a confirmed bull’s-eye rash, which indicates the signifi-
cant variability of rash presentation. This reflects humans’ inconsistent
presentation of the bull’s-eye rash. Researchers reported that the monkey with
the rash did not show positive antibodies upon testing, as the others did,
which was an interesting finding. Other forms of testing, including tissue
samples, showed that the monkey with the rash did indeed have a confirmed
exposure. Their theory was that the spirochetes might have stayed in the skin
for a longer period of time, delaying the overall antibody response.
Testing was unable to show consistency with antibody response in
antibiotic-treated monkeys versus untreated monkeys. The treated monkeys
were given a twenty-eight-day course of doxycycline sixteen weeks after
inoculation.2 All the monkeys were tracked for months afterward to check
antibody variability, and persistent B. burgdorferi was found in both cohorts—
the five treated with an antibiotic and the five left untreated.
This type of research is essential because there is so much certainty in the
current medical model that spirochetes do not and cannot persist after
medication has been administered. This is a common belief communicated by
medical professionals based on the constructs of the IDSA criteria. Testing
and the presence of a rash are used as criteria for administering treatment. Yet
how can these be the only criteria when there is so much variability in host
immunity, coinfections, bite location, genetic predisposition, and the variabil-
ity of immunoglobulins used to confirm presence? Lyme disease persists; this
is the core truth.
If you accept that Lyme disease persists, it’s clear that continued treatment
of some sort would be more advantageous than throwing our hands in the air
and saying there is nothing else that can be done. Remember, many Lyme
disease patients, particularly those who live in an endemic area, have accumu-
lated exposure to tick-borne infections over time. Seeing a patient with
persistent symptoms and not using available therapies to treat an infection
does not make sense, considering the risk-to-benefit of developing chronic
illness in the future. This failure to treat concerns not only Lyme disease but
also other infections such as babesiosis, anaplasmosis, bartonellosis, and
Rocky Mountain spotted fever, which can also persist; all are placed under the
same umbrella as Lyme disease, even though they might involve a very
different morphological experience in the body and could require antibiotics
different from those that would be prescribed for Lyme disease.
I have not personally seen antibiotics create severe irreversible immune
dysfunction or issues with drug resistance, which is frequently quoted as a
reason to refrain from treating with antibiotics. I have treated more than four
thousand patients with tick-borne disease, and I can say that treatment—
whether it is with antibiotics, natural medicine, or an integrative medicine
approach—overwhelmingly improves a patient’s health status as the infec-
tions/toxins are cleared and the immune system becomes able to fully recover.
Treatment for tick-borne infection is not a one-size-fits-all process, and each
patient’s journey is different.
A Complementary and
Alternative Medicine Approach
This is an interesting time for Lyme disease: There is a great deal of denial and
many polarized views regarding the disease in mainstream medicine, and the
gap is being filled by complementary and alternative medicine (CAM), which
is bringing forward promising new treatments. These innovative therapies
include hyperthermia treatments, low-dose immunotherapy, healing with
oxygen, nutraceuticals, intravenous medical protocols with ultraviolet light,
intravenous nutrient therapies, stem cell therapies, botanical/essential oils as
antimicrobials, energy medicine, and magnetic therapies. We will discuss
many of these treatments further in upcoming chapters.
Most medical trade shows and conventions for tick-borne disease focus on
CAM therapies, and vendors fill the halls so that doctors can learn all that
natural medicine has to offer. The train is rolling, and more practitioners are
jumping on board because the complementary medicine approach works.
Those who practice CAM, especially licensed naturopathic medical profes-
sionals, are trained to take the time to listen. We are drilled on taking a
thorough history and looking at the body as a whole system.
Most patients require a team approach because of the complexity of
tick-borne infection. Typically, one medical practitioner can’t be all things to a
patient. Depending on the complexity of the case, both a primary care
provider and a Lyme-literate doctor are often involved in patient care.
Typically, there are distinct roles for each. The Lyme-literate doctor will
What We Resist, Persists:
Restrictive Guidelines Limit
Access to Treatment
A CONVERSATION ABOUT RESTRICTIVE GUIDELINES has to start with a brief
discussion of the medical treatment guidelines commonly used to create
continuity of care in the different medical specialties. These guidelines are a
summary of published research, with protocols of care for many conditions seen
in clinical practice across multiple specialties. Usually, medical specialists with a
high level of experience and authority are chosen to be part of panels that
approve them.
Guidelines can be enormously helpful—they provide a reliable process for
treatment across the country, pooling information from research and clinical
observed data so practitioners can best serve patients. They can also be very
restrictive. The criteria currently in use to define Lyme disease are strangling
open discussion, compromising funding and research, and creating scandal by
maligning doctors for treating chronic Lyme disease.
IDSA Standards
The standards of care from the Infectious Diseases Society of America (IDSA)
for Lyme disease, Babesia, and anaplasmosis are a source of contention because
many practitioners, myself included, do not find the guidelines relevant to what
we experience in daily practice. According to a set of guidelines titled The
Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human
Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the
Infectious Diseases Society of America 3 last updated in 2006 (these guidelines
are being updated, but this process has been in the works for several years
already, with no issue date yet announced):
• Appropriate measures should be taken for prevention with topical sprays,
treated clothing, and tick checks.
• Medication and testing for a known tick bite is not recommended.
– If the practitioner decided to treat, they are encouraged to give a single dose
of doxycycline 200 mg.
• With the bull’s-eye rash or joint pain present, it’s recommended to give ten to
fourteen days of antibiotic therapy, with an additional four weeks if joint
swelling continues after initial treatment time.
• With neurological Lyme disease or cardiovascular infection, it’s recommended
to have intravenous antibiotics for fourteen to twenty-one days.
• Medications are not proven to be useful in chronic Lyme disease.
• Anaplasmosis and Babesia species should be suspected in those presenting
with tick bite with severe illness. Treatments are recommended for ten to
fourten days. Patients are to continue to be monitored with follow-ups up to
four to six months after initial treatment.
• For treatment of any Lyme disease manifestations, the following are not
recommended: “first-generation cephalosporins, fluoroquinolones, carbapen-
ems, vancomycin, metronidazole, tinidazole, amantadine, ketolides, isoniazid,
sulfamethoxazole-trimethoprim, fluconazole, benzathine penicillin G, combina-
tions of antimicrobials, pulsed-dosing (i.e., dosing on some days but not
others), long-term antibiotic therapy, anti-Bartonella therapies, hyperbaric
oxygen, ozone, fever therapy, intravenous immunoglobulin, cholestyramine,
intravenous hydrogen peroxide, specific nutritional supplements, and others”
The last bullet point is telling. This guideline is what insurance companies use to
inform their coverage. It is why, when you approach physicians about Lyme
disease, many do not want to discuss alternative treatments or differing points
of view. Guidelines for most conditions advise doctors what to do rather than list
medications and therapies not recommended. This feature is unique to this
document and explains why it has been so difficult for patients to get the help
they need and to get insurance coverage for therapies. Most treatments listed
here as off-limits are conventional.
The other important piece is the words at the end of the paragraph: “and
others.” This leaves the criteria for what is accepted and what is not very open
and difficult to define. The other language is concrete, with strict limitations on
treatment time and medications recommended. This does not leave a lot of
room for the doctor to address the individual case with progressive options.
If you continue with symptoms beyond the current IDSA treatment recom-
mendations, your condition is considered Post-Lyme syndrome. This means you
are no longer treatable, according to the guidelines—you’re stuck with it, and
palliative medications can help manage symptoms if a prescriber agrees.
Typically, language in the criteria leaves room for the doctor to exercise clinical
judgment for what is best for the individual. The Centers for Disease Control
(CDC) currently support and follow the standards of care laid out by the IDSA.
ILADS Standards
For every yin, there is a yang. The International Lyme and Associated Diseases
Society (ILADS) was formed in 1999 by a group of practitioners from a diverse
pool of specialties to create an alternative view of treatment for tick-borne
infections. It’s important for me to declare my bias as a member of ILADS, of
which I have been a member for several years. ILADS supports preventive
measures to avoid tick bites, just as the IDSA does. However, there are several
differences in the guidelines of the two organizations. ILADS guidelines, titled
Evidence Assessments and Guideline Recommendations in Lyme Disease: The
Clinical Management of Known Tick Bites, Erythema Migrans Rashes and
Persistent Disease4 and published 2014, state the following:
• Clinicians should not adopt single-dose therapy with doxycycline due to low
efficacy in the literature and clinical outcomes.
continued
• Treatment time for a new bite with an Ixodes species tick, no matter the bite time,
should be treated with doxycycline 100–200 mg twice daily for twenty days.
• Education about tick bites, care with antibiotic treatment to avoid secondary
infections, and prevention should be discussed in the office visit.
• “Watchful waiting” with delay in treatment increases risk of infection.
• Risk-to-benefit analysis shows that antibiotics need to be considered on a
case-by-case basis as an opportunity for patients to regain quality of life.
Withholding antibiotic therapy is costlier to the individual, the medical system,
and the economy.
• Re-treatment of chronic infection should not just rely on labs but on patient
reports of continued impairment related to initial infection.
• Medications and therapies should continue to evolve; practitioners should be
open to what is clinically observed to be effective and safe while honoring
patient choice.
Despite the efforts of both camps to stress preventive measures, the problem of
tick-borne infections is continuing to grow. We need all hands on deck for this
crisis. I align myself with ILADS because its criteria leave room for growth and
development. This approach is needed now more than ever to find the most
effective and efficient way to treat this growing problem.
handle all medications and care concerning treatment for Lyme disease, while
the primary care practitioner manages health concerns unrelated to Lyme
disease. The offices may run slightly differently, with varying hours of
availability, definitions of practice determined by third-party insurance, and
treatments that may be available.
Patients with chronic infections may require a lot of care and rehabilita-
tion. They will typically have a physical medicine specialist, either a chiro-
practor or a massage therapist. Patients may benefit from attending yoga or
meditation classes, and, depending on the level of physical impairment, may
also be referred for formal occupational therapy or physical therapy. Many
patients also have an acupuncturist to provide pain management.
If a patient experiences stress, anxiety, or depression, regular visits with a
counselor can be beneficial. Experiencing chronic Lyme disease is a form of a
trauma, so it’s important to have proper support set up to cope. Some patients
also seek out energy medicine practitioners, such as Reiki therapists, medical
empaths, shamanic healers, sound healers, and biomagnetic pair therapists—
just to name a few. Energy medicine offers another way to enhance the healing
process, reduce pain, practice self-care, and improve well-being.
Dr. Google
ON BEHALF OF ALL DOCTORS, I would like to discuss Dr. Google. In the Lyme
disease community, your search engine may be all you have if access to medical
care is limited. Those with chronic health conditions are more apt to research
online to learn how to manage their health, whereas the doctor used to be the
primary source of information. This is a big change in a long-standing dynamic.
Far too often, however, Dr. Google’s advice is chosen over that of a live
doctor who knows your individual case. Once you have found a doctor, it’s time
to trust the process and set aside the copious research. The core issue is going
to be trusting your health care practitioner; if you don’t, find another one.
Internet research can become an obsessive habit. Are you feeling empowered
from the research? Are you missing out on spending time with your family or
getting adequate sleep at night because of your excessive research? Do you
have a medicine cabinet full of supplements you bought online because a site
you found said they were going to cure Lyme disease?
Internet research is a part of the consumer-driven health care movement, but
the Internet is saturated with information that has not been vetted according to
any professional standards. Yet because a claim appears on the Internet, people
may give it a high sense of validity. There have been many times when I felt a
particular medication would be best for a patient and the patient will agree, but
then he or she goes home, does some Internet research, and calls saying they
found information about the medication that scares them. I will always respect a
patient’s choice, but it is important to ask whether the choice is being made out
of fear or out of common sense. For your sanity—and for the sanity of your
medical providers—it’s sometimes healthy to step away from the computer.
Advocating for Yourself

with Doctors
Dealing with criticism from doctors without getting derailed is difficult, but
it’s a valuable skill to learn. Please don’t spend too much time defending
yourself with a disrespectful practitioner. It’s okay if a doctor does not believe
chronic Lyme disease exists; just move on and find someone who is more open
minded. I see many patients who want to change a doctor’s mind, change the
system, and convince disbelievers in the medical community that they are
wrong—or they become upset by doctors who did not provide support. Focus
on your healing, and then your service to making change will be in helping
others learn to advocate for themselves. I know many
of you have been through humiliating discussions,
Focus on your had invasive procedures, and been prescribed
healing, and medications that did not help. Holding on to anger
then your ser- just feeds the illness. It’s okay to be angry at the
disjointed system, but try to let your anger move
vice to making
through you to resolution instead of holding on to it.
change will What is truly important? That you work with
be in helping practitioners who have an open mind, a compassion-
others learn to ate heart, and patience with your process. Find a
proper support system of practitioners from different
advocate for
modalities: a Lyme-literate doctor, a primary care
themselves. practitioner linked with the hospital system, a
specialist (if needed) for other diagnoses being medically managed, a chiro-
practor, a massage therapist, a counselor, support groups, an energy medicine
practitioner, and a naturopathic doctor. Not all may have experience with
Lyme disease, but they can still provide valuable care to help you heal.
When you are approaching your primary care provider about Lyme disease,
be aware that in almost every state doctors are mandated by hospital regula-
tions to run the two-tiered testing for Lyme disease; they may not be able to
run a Western blot. In addition to requesting tests to confirm Lyme disease, ask
to have coinfection tests run. Depending on the state where you live, you may
not have insurance coverage for a naturopathic doctor or a Lyme-literate
specialist if the doctor is out of network. You can ask your primary care
provider to work with your Lyme specialist to run labs for coverage as needed.
A handful of patients in my practice have HMOs that require them to get a
referral from their primary care provider to see a specialist.
It’s important to keep all doctors you are working with fully informed by
sharing lab work and reporting all medications you are taking, including
supplements. It is critical, for your safety, to avoid medication interactions. In
addition to medicines that may interact in a dangerous way, many supplements
can have adverse reactions with pharmaceutical medications. You may be
nervous to tell a medical doctor you are treating Lyme disease or using
alternative medications. Many doctors may not understand the training of a
naturopathic doctor and have varying opinions about the naturopathic doctor’s
ability to practice medicine. They may also not agree with the treatment of
Lyme disease, especially if you are working with a rheumatologist or neurolo-
gist who believes your issues are due to a different diagnosis. Talking with your
medical doctors about Lyme disease may be uncomfortable, but it is important.
I encourage transparency in my treatment plan and leave an open door of
communication with all other practitioners who work with my patient.
As a general rule, when working with more than one practitioner, only one
doctor should be prescribing medications for the tick-borne infections. You
can have a different specialist who may prescribe pain management medica-
tions, blood sugar–regulating medications, or medications to manage elevated
blood pressure. To maintain the integrity of your treatment, leave the pre-
scribing of antibiotics and those medications related specifically to Lyme
disease to one person. This is my rule if a patient is seeing other practitioners
who parallel my specialty, such as a Lyme-literate M.D. I am perfectly fine
managing the natural medication protocols but will not be involved in
prescribing antibiotics.
Finally, do not be afraid to be assertive. As I said before, it is okay if your
doctor does not believe you. It is fine if your doctor does not agree with your
treatment choice, as long as the provider is professional and compassionate.
Speak up for what you want in terms of your health care. Remember, the doctors
work for you. Doctors have to set proper boundaries to maintain professional
expectations and ensure safety within their scope of practice, but your opinion
on your health care matters. Your treatment needs to match your values and
beliefs and must meet you where you are in life to be truly successful.
Chronic Tick-Borne Disease

Is a Family Affair
Social support is one of the most important parts of recovery for Lyme
patients, who frequently feel abandoned by their family and community. Being
supported is not just about having physical help; it is about being able to go
through the recovery process without having to explain or defend the illness.
Lyme patients need to be able to have the recovery process take the time it
takes and feel unconditionally loved, especially by their family.
The fact that recovery times are more than a year makes Lyme disease
very difficult on caretakers as well as on sufferers. Services or support systems
must be in place for all involved. When someone is first diagnosed, I assess for
social support, physical support, and the general sentiment in the household.
Is there good communication between parties? Does the caretaker or loved
one believe the patient has Lyme disease? Does the family communicate with
compassion? Is an overabundance of worry placed on the patient? How much
fear is there? Is the person expected to get well too quickly? Is the patient
coddled to the point that it is hindering progress? Is the patient treating his
family well or showing poor emotional control?
Often, a Lyme disease patient feels she is a burden to loved ones, and this
feeling can lead to deep depression. Depression reduces immunity, decreases
quality of life, and fuels suicidal ideation in many. The truth is, Lyme disease is
a family affair. If a person is debilitated with Lyme disease, the entire family
dynamic will change—physically, mentally, emotionally, and financially. This
change affects the marriage, parent-child relationships, financial plans, job
standings, and the quality of family life.
An interesting phenomenon is that, though chronic Lyme disease is well
known in the media, in communities with epidemics, and within families, people
still tend to be wary of discussing their illness with others. They do not tend to
share the fact that they are struggling with Lyme disease with others in their life.
When I say “they,” I mean not only the patient but also the whole family. The
stress of Lyme disease is extremely difficult to handle for spouses, children, and
extended family, as well as the patient. Damage is done when a person feels the
need to hide physical, mental, and emotional pain because he doesn’t want to be a
bother, and when he resists being honest about suffering to spare others stress.
Lyme disease patients may fear being judged by others and worry that friends or
relatives think they are making up symptoms or milking the situation.
Start by being authentic about how you feel and letting go of the shame
associated with having Lyme disease. Recovery is a difficult process, and you
will need to process emotions so stress does not build up. It’s especially
important to make space for emotional release and to have healthy outlets
such as meditation, yoga, prayer time, writing time, and even crying time.
Crying loosens what is tied too tight. Let the tears flow if they arise. Then
share your feelings with others if you need to. Realize they can’t fix all your
ills, but they can listen and hold space for you to process. This is also about
cultivating healthy boundaries for all involved so that expectations are clear
about how much a person can give and also what you would like to receive.
Seeing a counselor who can work both with you individually and with the
family can be a healthy way to address the stress from the get-go by develop-
ing healthy communication and coping mechanisms. You’ll need to have an
understanding in the household about the importance of creating an environ-
ment suitable for healing with adequate rest, nutrition, and stability through-
out the process.
It’s also essential for the mental stability of the Lyme disease patient that
she is believed. A person can more easily face disbelief in the medical commu-
nity or at work if loved ones reflect unconditional support. If this is not the
case, recovery can be much more traumatizing and prolonged. Believing the
impact of the Herxheimer reaction (discussed in chapter 6) is also vital—for
patients of all ages. It’s incredibly painful for the symptoms to be dismissed as
an authentic response to the infection.
Support groups are popping up all over, driven by a grassroots movement
to help those who are struggling. Meetings are typically held at churches,
libraries, health clinics, and individuals’ homes. They can offer a welcoming
place where you do not need to explain what you are going through; it’s
already understood. Meeting others who feel as you do is helpful in dealing
with the loneliness and isolation of the disease, and in assuring you that your
process is normal. Cultivating supportive relationships is also wonderful for
the immune system!
Representing Yourself to
Workplaces and Schools
Working while recovering from Lyme disease and coinfections is very
difficult. You may feel pressure to stay employed, be seen as competent, and
avoid discrimination, depending on the sentiment toward the disease in your
workplace. Many people do not have flexibility to take time off from work or a
guarantee that their job will be waiting for them. If you hide the fact you’re
sick yet your performance suffers, you could lose your job based on the
perception you are not capable or committed.
To protect yourself at work, document your illness if it is chronic and
requires long-term treatment. This is usually done through paperwork
associated with the Family and Medical Leave Act. Though there are a
number of caveats and eligibility requirements, this federal law can protect
the individual who is ill and a caretaker who will require time off work. You
will be able to report your diagnosis, prognosis, and treatment, and make
accommodations for more frequent breaks as needed and approved time off
for doctor’s appointments. This is another way to help support your recovery
and be transparent with your employer while protecting your job.
Pressure similar to that placed on adult employees can affect children, who
tend to want to keep the illness secret and try to keep up the pace at school,
without much success. Teachers who don’t know the child is ill may think
parents are just not following through by monitoring homework and study
time. Poor performance on tests or assignments can lead to the child being
penalized, which just creates a more difficult environment in which to succeed.
Kids can lose confidence, which is difficult to recover from at a young age.
Paperwork commonly done to help with accommodations for school
include 504 plans and individualized education plans (IEPs). These plans are
made in conjunction with parents, school personnel, and the medical
practitioner and can help by making absences excused, evaluating ways the
school staff can help the student be more successful, providing more time to
complete work, and designating alternative testing environments to aid
concentration. Nursing staff within schools have been helpful in administer-
ing doses of probiotics or supplements for my patients as needed.
Lyme Denial:
Delaying the Inevitable
An all too common phenomenon among Lyme disease patients is denial of the
disease. Some patients call the clinic, panicked that they have Lyme disease
and anxious to get an appointment as soon as possible. A few weeks later the
flare subsides, and they cancel the appointment because they are all better. A
month later, they are sick again with a flare and call in a panic, upset they
missed the original appointment and wanting another one. This pattern
sometimes repeats several times before I meet a patient, maybe a year later.
Many people will meet with me to be tested, or to have their children
tested, for tick-borne infection. After I take the history of the patient and
decide that there is enough evidence to support the idea of testing, I order the
necessary tests. If the results are positive, I report them, but often the patient
calls the office to say he believes he doesn’t have the infection. This is abso-
lutely his prerogative, and it’s his right not to pursue treatment. Yet, several
months later we will get a call from the patient, who comes in reporting how
sick he has been, and how afraid he was once he spoke with his primary care
doctor and showed the doctor the results. After seeing his health decline over
time, the patient is finally ready to move forward with treatment. Most
patients who enter this cycle experience regret about waiting so long and fear
they will not recover.
Sick children with parents who do not get along, such as those who are
separated or divorced, can also face difficulty when it’s time to decide on
treatment. Many children have one parent who spends more time with the
child and who feels the child requires treatment. The other parent (whom I
typically don’t meet) believes the child is fine because there is no such thing
as chronic Lyme disease. The child stays sick because both parents must
agree on the plan in order to move forward productively. Even if treatment
begins, maintaining regular doses of medications can be difficult, depending
on who the child is staying with at the time. It’s a complicated situation for
all involved.
Doctor-hopping is another common behavior,
rooted in the desire to find a magic pill that will cure
all. Patients become frustrated as they search for a
You can heal
treatment that will bring an end to suffering in the from tick-borne
same time frame that they would recover from a disease. This
routine infection. This leads them to jump on and off
may mean letting
protocols, move from one doctor to the next,
self-treat, and try many different options, often
go of the person
abandoning them before they would reasonably have you used to be
a chance to work. I feel this tendency has to do with and accepting
the fear of experiencing discomfort with treatment—
changes that
patients feeling unsettled and worry they are making
the wrong choice—and they think the next treatment
may be perma-
will be the answer they are looking for. They may nent, but in most
become concerned they are missing out on the “cure” cases, you can
if they stay too long with a treatment that doesn’t
dramatically
work immediately, or they worry that discomfort the
current treatment causes means it’s not right for
increase your
them. Hopping from doctor to doctor and abandon- quality of life.
ing treatments can also be motivated by a partner,
family members, or the parent of a patient. People want to be well—and they
want their loved ones to be well—and many try multiple avenues, exhausting
themselves chasing a cure.
On the flip side, it’s important to have a team approach to blending
treatment modalities. Changing your treatment strategy may be the right
choice for you, and it’s essential that you have providers from different
specialties available to help, but jumping from one to another does not help
you get well. Recovery from chronic tick-borne disease takes time, patience,
and persistence. Doctor-hopping behavior is much different from moving on
from a treatment if it’s not the right fit. Just be aware of your goal as you
decide to stop a protocol. Are you making the choice out of fear or placing all
your hopes on a promised cure that seems too good to be true?
You can heal from tick-borne disease. This may mean letting go of the
person you used to be and accepting changes that may be permanent, but in
most cases, you can dramatically increase your quality of life. I do not promise
a cure because that would be misleading. A specific protocol may be one
person’s answer but not work on the next, and finding the right treatment is
sometimes a matter of trial and error.
Finding the right treatment takes time, patience, and trust in the journey.
It’s not easy. As a medical professional, I get frustrated at times if an infection
does not resolve in the way I was hoping. There are many ups and downs
sitting in the doctor’s chair, as I see one patient feeling on top of the world and
the next in misery.
When I was a patient years ago, I had many emotional meltdowns and
questioned everything I was doing, including my career choice. If I could not
recover using the approach I recommended to patients, then what was I doing
with my life? I experienced all the same emotions I saw in my patients. It took
me two years of treatment, blending medications, physical medicine, and
energy medicine. I learned a lot from being a patient, and that experience has
been very helpful in my ability to treat others—this was one of the gifts the
healing process provided me.
In Summary
You are not alone—and my goal is to make sure you know this. Remember, the
politics around Lyme disease denial is not a personal attack—it’s bigger than
your individual case. This perspective allows you to release the burden of
defending yourself. Be prepared to face scrutiny for a while longer, until this
disease is better understood and given the compassion it deserves. Know that
others around you are experiencing the same challenges. Once you have
recovered, you can be the voice in another sufferer’s ear to nudge them to
investigate Lyme disease and provide them with compassion as you share your
journey. You can help another person with Lyme disease advocate for himself
and bring your greater perspective to reduce his suffering.
CHAPTER 6
SETTING
THE STAGE
FOR
TREATMENT
SUCCESS
aking the leap into treatment is difficult given the amount of fear
T surrounding a diagnosis of Lyme disease, the complicated politics, and

the need to weed through mounds of information with discernment. In
this chapter, I’ll address choosing the right supplements to make your
treatment plan sustainable. We’ll also look at the overall costs of Lyme disease,
what to expect with treatment, and how to structure your day with a medication
regimen—and we’ll take a deeper look at the Herxheimer reaction.
Choosing the Right Supplements

Not all products marketed to treat Lyme disease are as promised. Some make big
claims without delivering, while others are overpriced given the ingredients they
contain. Navigating treatment protocols can be difficult as you try to choose one
that is affordable and that you think you will be able to follow consistently, while
avoiding becoming overwhelmed by the options. You want the best out of your
115
medications but may not want to take so many
supplements that you are consuming more pills than
As a consumer, you are food in a day. At that point, you are digesting
it’s important more fillers and binders than nutrients from those
to ask what supplements. Most patients eventually reject treatment
altogether because of pill fatigue.
research backs
If your supplement list fills an entire page, you
up the claims may need to pare it down. Patients come to my clinic
being made with a grocery bag full of supplements they’ve
about a bought based on Internet research. This is known as
polypharmacy (concurrent use of multiple medica-
treatment or
tions) with supplements. It’s easy to become excited
a product. by promises found online and feel hopeful that this
supplement will be the magic pill that will get you to
the finish line quickly. The reality of tick-borne disease is that treatment will
involve taking more pills than you ever thought possible for longer than you
ever imagined, but moderation is still vital.
It’s important, too, to be conscious of the exact herb you are purchasing
and to be aware whom you are buying it from and whether the plant cultiva-
tion is sustainable. Many people are turning to large resale vendors to buy
supplements rather than purchasing them directly from the company or a
doctor. This tendency is motivated mainly by the urge to be frugal, which is
understandable; but it is important to ask how the independent seller has been
storing the supplement and for how long. The product may be cheaper, but it
may be a bargain because a seller wants to unload it. If the supplement is
expired or has not been stored properly, it may not carry the same potency.
Lyme disease patients and their families obviously want to get well as soon
as possible, which makes them vulnerable to marketing promises and anec-
dotal information. The FDA does not allow supplement companies to make
structure-function claims—this means that a company cannot say on the bottle
or in its marketing material that a particular supplement treats a disease. It
cannot say the supplement “treats ulcers” or “treats rheumatoid arthritis”; 1
instead, it may say something to the effect that the supplement “supports
healthy digestion” or “reduces inflammation.” As a consumer, it’s important to
ask what research backs up the claims being made about a treatment or a
product. Who paid for the research, and have other studies replicated the
results? Nothing and no one should be boasting they will cure you. This is not
to say statements such as this will not be made, but please question the ethics
and motives of someone who comes forth with such claims.
Patients in the Lyme disease community are exceptionally vulnerable
because they are desperate to recover. Many herbs and nutraceuticals have
proven themselves over time with observed data and beneficial outcomes.
Treatment needs to align with your life: to what you can commit to doing on a
daily basis, what you can afford, and what aligns with your values. It’s import-
ant to consider the risks and the benefits of any treatment path you choose.
Chronic Lyme Disease

Has No Quick Fix
We live in a culture that has limited patience for a body facing illness and
recovery. It has been about six years since my bout of chronic Lyme disease
and babesiosis, but while I was writing this book, I had a dream. I was walking
around my house feeling panicked that my symptoms were back. In the dream,
I had a thought that calmed me down: “Maybe now that Lyme disease is back,
I can get more rest.”
I woke up to realize I was not having a relapse, but I was left with the
dream’s message: I was overextended. I was not making enough time for
myself. My unconscious mind knew it would get my attention with the idea I
could be having a relapse. I bring this up because many patients resist rest and
are angry with the body for not getting well soon enough. They will literally
be brought to their knees before they make changes in their schedule that
allow them to recuperate. As they try to maintain the same work or school
load and social activities, they get even more aggravated with the body and
resist the need to simplify their lives. This resistance to making changes
prolongs the healing process, and the body is aware of the anger, responding
with reduced energy and lower healing capacity.
The average treatment time for chronic Lyme disease is six months to a
year. Treatment for an acute bite lasts only three to four weeks. These
dramatically different treatment times illustrate why it is so important to treat
a bite as soon as possible. It takes longer than you would think to recover from
chronic Lyme disease, and this fact will trip you up more than any other. I talk
daily with people who wonder whether they really do have Lyme disease,
since they are not well in two months.
Doubts surface as inner conflict, as you ask the following questions: “Am
I sure this is really Lyme disease?” “Is it okay that my recovery is taking so
long?” “Should I change treatment, see a new specialist, stop treatment?”
Then someone in your daily life asks you these questions in passing, reinforc-
ing your insecurity and creating more frustration. Maybe a new treatment will
get you to the finish line faster? You might get stuck mentally between a fear of
S E T T I N G T H E S TAG E F O R T R E AT M E N T S U C C E S S 117
moving forward and a fear of stopping. You will hit the wall many times, with
discomfort and impatience with the process. This is all normal. Understanding
that your thought process is typical and that you are not alone will hopefully
help calm your mental chatter.
Family members and friends, with all the best intentions, may also step in
to give advice. They might know a person who was cured by this supplement,
or they might offer the opinion that you don’t have Lyme disease, based on
their own Internet research. They might feel the same frustration you do as
they watch someone they care for suffering.
Once you start treatment, the first two to four months are the most difficult.
Symptom flares might be at their worst then, with the remainder of treatment
time featuring random flares as treatment gets to different layers in the body. It
takes time for toxins to be released and inflammation to subside. You can
expect to see improvement of most symptoms over time but will continue to
have difficult moments and require time for your health to be fully restored.
You will know you are close to finishing treatment when you forget for a while
that you are sick or when two months go by with no symptom flare. You may
also see symptom flares gradually become less severe and shorter in duration.
A phenomenon I refer to as the “four-month slump” commonly occurs
partway through treatment; during this slump, it feels as if you’ve taken twenty
steps backward in the treatment process. This usually hits patients hardest if
they were one of the lucky ones who saw immediate improvement with antibiot-
ics. I feel this happens because of a release of spirochetes that were dormant in
the cyst form, causing a dramatic Herxheimer reaction. As we discussed earlier,
Lyme disease spirochetes live in four different forms, one of which, the cyst
form, is shaped like a ball. This reaction does not occur with everyone, but it is
fairly normal. A slump or plateau may also indicate that you are due for a dosage
change, which is something to broach with your treating physician.
You may have a relapse or a flare well after treatment is complete. This
usually happens when either you were infected by new tick bite or you
experience a major stressor that jars the immune system. Stressors can be
another illness, a car accident, a devastating loss, a concussion, a sports injury,
or surgery; these events can place enough shock on the body that Lyme disease
resurfaces. Coinfections missed with the first round of treatment can also be
the culprit. Most cases are likely new bites.
Lyme disease recovery is a time to slow down and listen to what your body
needs. You must learn how to say no and work on any feelings of guilt that arise
when you step away from your typical pace. Lyme disease has its own timeta-
ble. Once you accept and understand this, you will experience great relief. Note
that doctors get just as tripped up by this anxious energy because we want to
see patients recover as quickly as possible. I have had to learn to manage the
emotions of coping with patients’ ups and downs without taking their progress
personally. A consistent meditative practice and energy hygiene practice make
this much easier. The less attached I am to the patient recovering within a
certain time frame, the healthier the process is for the patient. I don’t need to
be another person adding to the patient’s stress over expectations; instead,
I work to truly hold space for the patient to be authentic with the experience.
The Cost of Lyme Disease

Lyme disease is not your average infection, with loads of money being poured
into research; in fact, the opposite is happening. Considering the impact
tick-borne disease is having on communities across the globe, federal and state
governing bodies are spending very little to educate citizens, track the disease
process in humans, or research prevention and treatments for the disease.
Currently, the funding provided by federal and local governments in states
most affected is barely enough to pay for staff to track reported cases in local
Health and Human Services offices.
Around 2013, the Centers for Disease Control updated its reporting, giving
the number of infected persons in the United States per year as 300,000 rather
than the long-reported number of approximately 30,000 people. To put this in
perspective, there are 1.5 percent more Lyme disease cases each year than
there are breast cancer cases (200,000) and the rate of infection with Lyme is
six times higher than infection with HIV (50,000), as reported in 2014.
Chronic Lyme disease patients visit doctors five times more often and emer-
gency rooms twice as often as the average population. 2
Socioeconomically, it’s costing us all a lot to deny the presence of chronic
Lyme disease in the population. We are seeing increased numbers of disability
claims, higher health care costs, lower quality of life, reduced productivity at
work, and missed days of school. And we are looking at an enormous increase in
chronic disease in the population, which will be an ongoing economic problem.
It’s estimated that 42 percent of chronic Lyme disease patients cannot work
during their treatment, which means lost wages for the patient as well as
out-of-pocket expenses due to high deductibles and rejected claims, plus costs
for supportive treatments such as supplements. This can cost, on average, $1,000
to $2,000 per month out of pocket for patients who have medical insurance.
I spend a fair amount of time each week filling out disability forms and Family
and Medical Leave Act paperwork, on the phone advocating for patients with
insurance companies, and submitting prior authorizations for insurance coverage
for medications. Many people are forced to leave their jobs either to be a caretaker
to a family member with chronic Lyme disease or to care for themselves as they
are suffering from Lyme disease and are not well enough to manage at work. Most
of these patients had been working full time in well-paying professions with
healthy retirement funds that they must drain to pay for treatment such as
intravenous medications that are typically not covered by insurance companies.
In addition, there is the cost of palliative medications, lab tests, doctor’s
visits, and therapies for symptom management. Many patients require
medications to support the cardiovascular system, manage pain, balance blood
sugar, lower cholesterol, and control attention deficit disorder, as well as
anti-inflammatories and mood stabilizers—and the list goes on. My patients
usually have a list of five or more pharmaceuticals to report on the first visit,
based on all the doctors they have seen before coming to me. They spend large
amounts of money on blood tests, imaging studies, surgeries, medications, and
experimental treatments for other diagnoses before they are tested for Lyme
disease; Lyme disease is usually last on the list.
I never could understand the logic of denying antibiotics to someone who
is living in an area infested with disease-bearing ticks and who has several
questionable symptoms. It is especially bewildering if the onset of symptoms
was sudden. It is much more affordable to treat with a short course of antibiot-
ics and then, if necessary, escalate to more extensive testing to confirm other
conditions that involve long-term care. The cost of an antibiotic is low when
compared with the cost of palliative care for chronic conditions.
The most high-cost issue with tick-borne disease patients is the number of
hospital and clinic visits they require. Most patients report frequent emer-
gency room visits for chest pain and heart palpitations. Others go because of
vertigo, elevated body pain, and severe depression or anxiety. Most will be
given a sedative in the emergency room and sent home with a diagnosis of
anxiety. Many are treated like drug seekers or leave feeling dumbfounded that
doctors found nothing wrong, though they feel so sick. On more than one
occasion, patients say an emergency room doctor handed my name and
number to them, suggesting they contact me for help.
Maintaining the
Medication Schedule
If you are not used to taking medications, I’m sorry to tell you that you may
need to take more than you are comfortable with if you are to recover fully.
Eventually, however, the plan is to be off them altogether. Chronic Lyme
disease patients are often taking a long list of prescription medications before
their first appointment with me. Most common are those for mood stability,
inflammation, and pain management, as well as antiallergy medications,
antacids, antibiotics, immunosuppressants for autoimmune symptoms, blood
pressure stabilizers, antiseizure medications, cholesterol-lowering medica-
tions, sleep aids, and blood sugar regulators. Often, more than one prescriber
is involved.
One of the biggest difficulties in maintaining compliance with treatment is
finding a dosing schedule that does not feel burdensome. This is most difficult
for individuals who hate taking pills but who now must take them several
times in a day. For treatment to be successful, you will need to make sure you
lay out a plan for your daily life that allows your medication regimen to be
sustainable. I learned the hard way, through my own two years of treatment,
how easy it is to forget a dose. My children were very young when I had Lyme
disease, and I was easily distracted by their needs. I would come back a couple
of hours later to find my medications still on the counter. I found it was easiest
to plan dosing around mealtimes; this timing is conducive to a daily flow and
feels less intrusive.
When I’m working to devise a patient’s treatment plan, I first check in with
the needs of the family. For instance, if the patient is a child, I need to find a
dosing schedule that works for the parents and within the school schedule. If
multiple children in the family are being treated at the same time (which
happens far too often), the parents and I need to coordinate care in order to
avoid burnout. I also need to make sure the process is structured so that
dosing is consistent.
The same considerations apply for adults. In many situations, a patient
may not have the cognitive ability to remember to take medications regularly
and must depend on reminders such as cell phone alarms, family support, or
lists; most end up using pillboxes with the medications laid out daily. Lyme
disease patients also tend to have irregular sleep cycles, which makes regular
meals and consistent dosing difficult. Following are typical recommendations
for dosing:
• Take your antibiotics at breakfast and dinnertime. Some antibiotics

may need to be taken at least thirty minutes before eating. Remem-
ber that certain antibiotics, such as doxycycline (the most popular
Lyme disease medication) and minocycline, should not be taken
with food, dairy products, or mineral supplements because of the
reduced absorption of the medication. In this case, it’s best to take
your medication thirty minutes to an hour before your meal. Please
check the prescription bottle for special instructions from the
Herxheimer Reaction
JARISCH-HERXHEIMER REACTION, often referred to as simply a Herxheimer
reaction or Herxing, is a common phenomenon in the treatment of tick-borne
infections. It’s named after two scientists who recognized a unique reaction in
their patients while treating syphilis, another spirochete infection, in the early
1900s. As the spirochetes are attacked by medications or the host’s immune
system, endotoxins are released, increasing inflammation in the area where the
pathogen is located. This can occur in multiple organ systems, making it difficult
for patients to tolerate the medication due to increased body pain, neurological
symptoms, headaches, fatigue, fevers, mood instability, and rashes. Unfortu-
nately, this reaction is the rule rather than the exception. It can happen within a
few hours of initiating treatment or may be as delayed as four weeks. The reaction
can last several months, with the worst typically happening within the first two
to four months of starting treatment. A Herxheimer reaction is the number one
reason people stop treatment, and the fear of this reaction can stop people cold
at the thought of being unable to work or take care of their family. Supporting
patients emotionally as well as physically through the process is the most
important factor in treatment success.
The intensity of the Herxheimer reaction depends on how long the infection
has been with the patient, how many other tick-borne infections are present in
the body, how well the patient’s detox pathways are working, and how much
the patient fears suffering. Patients who have a history of unresolved mental,
emotional, or physical abuse can have greater difficulty because they may feel
victimized all over again when the pain increases. The reaction can trigger
post-traumatic stress disorder, leading to intense fear and anxiety. Patients may
experience a fight-or-flight response at just the thought of taking treatment,
including flashbacks, panic attacks, and emotions so intense they can have
thoughts of self-harm. Patients may benefit from a referral to a counselor who
specializes in trauma. For most people to recover, they must tolerate treatment
consistently over time.
Symptoms will come and go periodically, sometimes varying with the hour or
the day. The infection is turning the corner when the flares are less severe and
less frequent; eventually, there are days when the patient forgets she is sick.
Disappearance of symptoms becomes the benchmark for identifying the end of
therapy. Over the years, my criterion for stopping treatment has been two
months with no symptoms related to Lyme disease or other coinfections. It’s
also important to understand that the Herxheimer reaction can occur in
response to other situations as well: when the body is clearing toxins such as
yeast overgrowth, when fasting, or during chelation therapy for heavy metals
intoxication. This means the treatment plan must always support detoxification
pathways by including toxin-binding supplements and nutrients that encourage
the production of glutathione, a potent detoxifier made by the liver.
Below are tips to support you through the process:
• Remain calm. Every symptom you have had that is related to your tick-borne
illness could amplify. Symptoms may come and go in irregular patterns. Rest
as much as you can.
• Stay well hydrated and set a goal of drinking half your body weight in ounces
of filtered water each day.
• Take a sauna (set the temperature to 120°F [49°C] and start for five minutes;
gradually work your way up to fifteen to twenty minutes).
• Soak in a bath to which you’ve added two cups of Epsom; this will help the
body in removing toxins.
• Take Alka-Seltzer Gold (for those over nineteen years of age because it
contains aspirin) or electrolyte powders added to water. This remedy can
reduce headaches and nausea, improve clarity and energy, and relieve mild
body pain. Use as directed and as needed for support.
• Take liposomal glutathione, one teaspoon one or two times daily by mouth or
of 1–2 g two or three times per week administered intravenously. Glutathione is
a powerful antioxidant that is important to the body’s detox process; it
supplements a protein compound already made by the body in the combina-
tion of L-glycine, L-cysteine, and glycine.
• Practice meditation or do gentle yoga to promote a balanced nervous system
and healthy blood flow, which will help remove toxins.
• Recognize that it is normal to experience a Herxheimer reaction with Lyme
disease and other tick-borne infections. While the reaction may not be
perceived as normal by others, know that it is common.
pharmacy. If you still have questions, contact your doctor or

pharmacist to confirm proper timing. A majority of antibiotics are
preferably taken with food to avoid nausea and help in absorption.
• Take your supplements at lunchtime and before bed. This schedule
keeps a healthy distance between doses of your probiotics and
antibiotics, which will give you the best outcome. It also breaks up
the number of pills you must take at one time, so your digestive
tract is not overwhelmed.
• Work with your prescribing doctor to factor in timing of any other
prescription medications you are taking. A common medication is
thyroid replacement, which requires dosing first thing in the
morning, one hour away from food or other medications.
Don’t worry if you miss a dose. You have not
screwed anything up if your day does not work out
What patients the way you wanted and doses aren’t perfectly timed.
don’t know… can If you can, try to fit the missed dose in later, but not
lead to impulsive at the cost of lost sleep or the digestive upset that
may come when you take too much medication at
decisions and
once. Just start over again the next day. If scheduling
panic, causing mishaps happen frequently, discuss your dosing
harm in the end. timetable with your prescriber so you can rework it
in a way that better suits your life.
In Summary
You are now better prepared for treatment of chronic tick-borne infection.
The information in this chapter is meant to empower you, encourage you to
stay the course with treatment, and learn to troubleshoot situations as they
arise. I find that what patients don’t know—the experiences they have that
they fear aren’t normal—can lead to impulsive decisions and panic, causing
harm in the end. An open dialogue about recovery makes the process more
tolerable. Next, we will discuss the Foundational Naturopathic Treatment
Plan, the nuts and bolts of the most important supplements to support the
physical body through the recovery process.
CHAPTER 7
THE
FOUNDATIONAL
NATUROPATHIC
TREATMENT
PLAN
he Foundational Naturopathic Treatment Plan is about sustainability
T during a difficult recovery process: A treatment is not worthwhile if a

patient is unable to comply either physically or financially. My require-
ments are that a treatment plan be reasonably priced for the majority
of patients, easy to implement, and proven safe and effective. It needs to help
patients feel more hopeful without making over-the-top claims of a cure.
Treating Lyme disease and associated infections is a big subject. There are
so many different protocols that exploring the best options can feel truly
overwhelming. Over the years, I have seen many treatment fads for Lyme
disease come and go, and at this stage in my medical career I’m discerning
about what I implement in my practice. My goal is to give you an understand-
ing of options for treatment. I have honed this plan not only as a naturopathic
doctor but as a Lyme disease patient who had to work medications into the
flow of my life. The treatment goals I have for each patient are as follows:
• Reduce inflammation and pain.

• Treat the infections with a blend of complementary medications.
125
• Balance the hormone system with nutrients, herbs, and bioidentical
hormones.
• Improve detoxification pathways by supporting organs of elimination
and greening your life.
• Boost immunity through herbal support, stress management, and
proper nutrient balance.
• Balance mood, increase clarity of thought, and promote empower-
ment and sleep regularity to improve well-being.
• Support a heathy digestive tract.
• Improve strength and endurance with movement.
Whichever direction you choose—either blending natural medication with

antibiotics or taking natural medications only—I want to provide you with a
foundation to build on and maintain a healthy physical structure to make
healing more efficient. Whether the option I present stands alone as your
primary therapy or in combination with other modalities, these options should
be at the core of helping you restore your health. In the back of the book, you’ll
find a handy reference section with charts that detail the herbs and nutrients
discussed in this chapter.
Maintaining a
Healthy Microbiome
Trillions upon trillions of microbes colonize the tissues of our bodies, both
internally and externally, and a diverse microbiome contains protective yeast,
parasites, and viruses as well as bacteria. These microbes are our guards at the
gates. They protect us by secreting their own antimicrobial substances to ward
off invaders, educating our immune system and balancing inflammatory
responses to aid in healing. These microbes change depending on the needs of
the body.
The Human Microbiome Project, started in 2007 by the National Institutes
of Health, was pivotal in gaining an understanding of the complexity and
diversity of the microbes living in our inner world. Before this initiative, many
microbes could not be isolated or cultured outside the body with an external
medium. Bacteria, funguses, protozoa, bacteriophages (viruses living on
bacteria), and other viruses make up a whole universe living within the human
body in a co-creative relationship. The human body hosts more than ten times
the number of microbial cells as it has human cells, and the Human
Microbiome Project uses genetic sequencing to understand microbes, their
role in human health, and the strains that are more prevalent in certain
groups. The more we understand how microbes interrelate and how they
relate to the human body, the more we understand ourselves.
Maintaining healthy microflora is one of the most important aspects of
treatment in every infectious disease treatment protocol. Every patient I treat
is on a high-dose probiotic to combat the risks of developing yeast overgrowth
or a more dangerous infection, Clostridium difficile. C. difficile is most com-
monly picked up in medical facilities, but it can be acquired elsewhere. Those
over the age of sixty-five are most at risk for severe consequences as a result of
age-related immune compromise. With proper amounts of probiotics and
beneficial yeast, these infections can be avoided. I have seen only three cases
of C. difficile in more than a decade of practice, though I have used antibiotics
to treat several thousand patients with tick-borne disease. I attribute this to
proper support of the human microflora.
Once relegated to health food stores, probiotics have become a household
word, with big companies adding them to yogurts and other foods, and chain
stores stocking them in the vitamin aisles. There are many probiotics on the
market, with the main bacterial components of these being Lactobacillus and
Bifidobacterium. Some cultures found in probiotics at the health food store
seem as if they are infections—Streptococcus, for example—but they are
actually part of a healthy microbiome, and the treatment goal is to promote
several different strains. For many of the nonbeneficial microbes we come into
contact with, there exists a beneficial microbial counterpart. We have a
germ-phobic culture, but it’s important to understand that approximately 98
percent of microbes are not harmful.1 Globally, they are responsible for oxygen
production, soil regeneration, degradation of toxins, and fermentation of
commonly consumed foods. 2
Each human gut has a diverse microbial population, the makeup of which
depends on early life exposure to microbes, health status, genetics, and local
environmental factors. Your gut is one giant “super organism,” and without it,
you would be unable to tolerate food without experiencing repeated infec-
tions. Although the gut is within the body, it faces outward, like the skin, with
microbes living both within the body and on the surface of the skin. The
microbiome is a layer coating the surface of the digestive tract, our oral cavity,
the vaginal canal in women, our sinuses, under our fingernails, and on the
surface of our skin, with different pathogens colonizing specific areas
depending on the requirements of the body. Beneficial microbes are responsi-
ble for vitamin production, neurohormone production, mood regulation, food
cravings, and immune regulation affecting gene expression; and they inform
us about the outside world. When we travel, we are exposed to new microbes,
T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 127

Microbes:
Friends with Benefits
PEOPLE WORLDWIDE ARE INCREASINGLY INTERESTED in delving into their
genetics, so why not also get to know the micro-friends that are unique to you?
Each individual has a distinctive set of microbes, a bit like each has a unique
fingerprint, with more than a thousand species living in the human gut. If you
want to know more about your own gut ecology, I highly recommend taking the
Ubiome test (www.ubiome.com) or the Gut Zoomer by Vibrant Wellness.
Laboratories test the human microbiome either by looking at the 16S rDNA, a
protein subunit present in every microbe that helps identify the microbe’s origin,
or through metagenomics, which tells us more about the role microbes play in
the human microbiome. Depending on the test, you can get an idea of the
microbes within your digestive tract or, if you’re a woman, your vaginal flora.
These tests can be very helpful in getting answers about persistent constipation,
diarrhea, bloating, inability to lose weight, and many other troublesome prob-
lems. It’s important to know more about the trillions of microbes that live with us
daily and protect against invaders, produce vitamins, and regulate metabolic
function. They are our friends with benefits.
which help us adjust to the new environment. Even in our own environment,
the incoming microbes share information and increase our adaptability to our
environment by informing the immune system. 3
S U P P L E M E N T I N G W I T H P R O B I OT I C S
Ideally, a probiotic will have at least 50 billion to 150 billion colony-forming
units (CFUs) per capsule to minimize the number of pills that must be taken in
a day. Many of the brands on health food store shelves will have doses ranging
from one million to twenty billion CFUs per capsule, which is perfect for a
routine daily health regimen but not suitable to take with antibiotic therapy.
The higher-CFU probiotics can be more expensive than the ones found at the
grocery store, but it’s worth the price to avoid side effects.
In addition to over-the-counter products, there are prescription probiot-
ics with four hundred to nine hundred billion CFUs per dose in sachet
packets. These mega-dose probiotics—including VSL #3, VSL Double
Strength (DS), UltraFlora by Metagenics, and Ultimate Flora by Renew
Life—were developed for more severe intestinal inflammatory disorders such
as Crohn’s disease and ulcerative colitis. I often recommend doses this high,
but it’s important to discuss specifics with your provider; be sure probiotics
are included in your treatment plan if an antibiotic is part of the course of
treatment for tick-borne disease.
Note that, because most probiotics should be refrigerated, people often miss
their dose in the middle of the day if they aren’t at home or don’t have a refriger-
ator at work. The probiotics I recommend are stable at room temperature for
five to nine days, but brands vary in their recommendations. It’s okay to bring
your probiotics with you during the day in your purse or in a pill case so you can
get your lunchtime dose. Consistency makes a big difference in the long run.
S U P P L E M E N T I N G W I T H P R E B I OT I C S
Inulin, glucomannan, and fructo-oligosaccharides (FOS) are known as
prebiotics, and are frequently given alongside a probiotics regimen. Prebiotics
help feed the beneficial bacteria in the digestive tract, supporting them as
they do their job of supporting you. Research has shown that konjac gluco-
mannan, a prebiotic fiber supplement, provides protective benefit to the
important gut microbe Bifidobacterium, the most abundant beneficial
microbes in the human body.
Glucomannan protects native Bifidobacterium when patients are being
treated with the antibiotics tetracycline, streptomycin, and penicillin.4 This is
due to the ability of konjac glucomannan to absorb toxins that would harm
Bifidobacterium. This prebiotic would be helpful as an addition to your
probiotic regimen while on treatment; the usual dose is one-quarter to
one-half teaspoon added to water one or two times per day. Inulin and FOS
have also been shown to decrease the symptoms associated with irritable
bowel syndrome, Crohn’s disease, and ulcerative colitis. 5 A common side effect
of prebiotics is bloating, which typically resolves over time as the gut adapts.
E AT I N G A F LO R A - S U P P O R T I V E D I E T
Since the beginning of time, the environment has provided biodiverse
microbial species that colonize the human body. Our first exposure is from our
mothers in the birth canal; then we are exposed through breast milk, family
pets, other humans, and foods—and by playing in the dirt as children. With
changes in agricultural practices, modern diets that include a large percentage
of processed foods, and the introduction of antibiotics, the need for supple-
mentation is growing. But foods that support a healthy flora will provide your
body with nutrients it understands how to utilize more fully. While a pill gives
a controlled and measurable dosage, it’s still limited to the strains that are
easily procured and can be made shelf-stable. A variety of foods offers a wider

array of beneficial microbes, and the more diverse
the flora you take in, the healthier your immune
A variety of system will be.
foods offers Patients often ask if they can eat yogurt or other
a wider array fermented foods in lieu of taking a probiotic during
treatment. My answer is no—not while you are on
of beneficial
antibiotics. It’s important to take the higher-dose
microbes, probiotic pills if you are on an antimicrobial regimen
and the more because the prescription and natural antibiotics will
diverse the flora attack your beneficial gut flora as well as the
microbes you want to get rid of. In addition to taking
you take in, the
a probiotic, increase your intake of fermented foods
healthier your such as yogurt, kefir, sauerkraut, miso, tempeh,
immune system kimchi, and kombucha. Even when your treatment is
will be. complete, continue eating these foods to enhance
immune function; it’s a beneficial lifelong habit.
Fiber, discussed above as a prebiotic, as well as those naturally occurring
in fruits and vegetables, will help feed your beneficial bacteria by producing
something called short-chain fatty acids. These create butyrates, which are
food for the cells of the colon. The right balance of soluble and insoluble fiber
is key. If your diet consists of mostly fruit, vegetables, and whole grains, and
you have a moderate intake of animal protein and healthy fats, you are on the
right track. If three-quarters of your plate or bowl is filled with plant-based
foods and one-quarter is animal protein, you have an ideal ratio to support a
healthy digestive system. For some, that amount of roughage may be too much
for the gastrointestinal tract to handle; pulverizing vegetables and fruits in a
blender and adding them to smoothies or pureed soups, or lightly steaming
vegetables, can make them more digestible.
SUPPORTING BENEFICIAL YEAST BAL ANCE

Beneficial yeast is an important part of the microbiome, and it works in
synergy with beneficial bacteria. When probiotic formulations are made with
a blend of beneficial bacteria and beneficial yeast such as Saccharomyces
boulardii, they have been found to improve treatment outcomes in cases of
diarrhea or unhealthy colonization in the gastrointestinal tract. 6 Colonizing
beneficial yeast is important to defend against pathogenic yeast cultures such
as Candida albicans.
I want to touch briefly on a phrase used in the natural medicine world that
patients often find confusing: I would like to step away from the phrase
“systemic yeast overgrowth.” A majority of yeast infections present in the
body infect the surface only; even in the digestive tract or the vaginal canal,
yeast are still on an external surface. The most common yeast pathogen is C.
albicans, which adheres to tissues and triggers inflammation, causing fatigue,
itching, gas and bloating, and changes in the skin and nails. This may also
present as thrush (yeast overgrowth in the mouth), chronic vaginal yeast
overgrowth, slow-growing patches on the skin, or red, moist lesions in the
folds of the skin. Once the yeast attaches to tissue, it secretes enzymes that
break down fats, cell membranes, and proteins.7 This is probably why the term
systemic is used, but the real problem is the buildup of systemic inflammation,
not free-floating yeast molecules in the bloodstream.
In severely immunocompromised patients, colonization of yeast can
happen in the organ systems; this is common in those who are suffering with
HIV/AIDS, advanced diabetes, end-stage cancer, and other life-threatening
illnesses. Typically, that sort of infection requires hospital-level care for
candidemia (the presence of yeasts in the blood). Cryptococcus neoformans, a
type of yeast, is commonly associated with life-threatening meningitis and
can be drug-resistant to antifungals. However, this condition is rare.
The yeast infections I typically see are routine Candida overgrowth in the
gastrointestinal tract, oral cavity, vaginal canal, skin, and nails. Many patients
who present to my clinic with chronic Lyme disease have been ill for a long
time and are already colonizing yeast; if this is the case, they are treated right
away for overgrowth. The most common are chronic nail infections. However,
once the internal yeast is balanced, the nails grow heathy again. It’s very rare
for patients with yeast overgrowth to get to the point that they require
hospital-level care. In all my years of treating patients with antibiotics, I have
never seen it. If a yeast overgrowth escalates and requires that high a level of
care, a more serious illness is usually the underlying cause.
Those with chronic Lyme disease can have reduced immunity, allowing
overgrowth of surface yeast, so it’s important to evaluate for Candida with
blood work before starting treatment, to avoid further complications. Blood
tests for C. albicans are looking for antibodies that have been triggered by an
immune response, due to exposure to nonbeneficial C. albicans in the gastroin-
testinal tract.
Treatment for yeast overgrowth depends on the severity of the infection.
Natural yeast treatments are gentler and may be effective, but in some cases
antifungal medications are the best course of action. Yeast can also create
biofilms, which make an infection more difficult to treat. Most patients I see
opt for natural treatments and make big changes in diet to correct the
problem. This usually does the trick. Those who need more immediate care
because of difficult symptoms can be treated with pharmaceuticals. This is a
short-term solution offered with the idea that the patient will also make
necessary changes such as reducing their intake of refined sugar.

Conventional medications aimed at eradicating pathogenic Candida are
working to block the production of the vitamin D2 derivative Ergosterol. A
study published in 2015 in the Oxford Journal found that supplementation with
vitamin D3, which is more easily utilized in the human body than vitamin D2
(the plant form of vitamin D), was helpful in reducing the pro-inflammatory
effects of Candida in mice. The study also found that people hospitalized for
yeast infections of the blood were more likely to have low vitamin D levels.
Based on this finding, you might think that higher doses of vitamin D would be
helpful, but the research showed that a mild to moderate dose was a better
option. Higher-potency dosing was actually counterproductive, supporting
conditions ripe for yeast.8 Unfortunately, the study did not give optimal dosing,
which means there is still no clear consensus on dosing strategy.
E AT I N G A N A N T I -Y E A S T D I E T
The best way to keep yeast in balance—better than any supplement—is with
diet. Treatment failure for yeast and for tick-borne disease is more likely if the
patient continues to consume foods made with white flour, white sugar, and
high-fructose corn syrup while they are being treated for a yeast infection.
Botanicals with powerful antifungal properties are also an option. Beneficial
microbes can crowd yeast out, so consider supplementing with Saccharomyces
boulardii, a beneficial yeast. The other way to kill yeast is to stop feeding them.
If you feed a seagull bread, twenty others will arrive wanting more. Yeast is
like those gulls. It loves sugar, and the most delectable items to yeast are
processed simple carbohydrates such as flour, processed sugars, and
high-fructose corn syrup. If most of the food on your plate is white, beige, or
brown, you are eating a yeast buffet.
Sugar is highly addictive, and eliminating it can cause an emotional reaction.
I have seen many people become highly emotional—easily angered or sad-
dened—after they’ve tried removing bread, pasta, and high-sugar foods from
their diet. The body becomes accustomed to having a certain amount of sugar,
and microbes want their fix as well. When you stop eating sugar, signals to the
brain stimulate sugar cravings. As with cutting out any addictive substance,
removing sugar from your diet could make you cranky, tired, or nauseous until
your body recalibrates itself. On the flip side, when someone commits to making
this change and is able to make it through the withdrawal symptoms, she
experiences dramatic changes in her physical body. These changes include
weight loss in individuals with a history of difficulty losing weight, healthy nails
after long-term fungal infections, and improved digestive health.
I have found the Whole30 program highly effective for patients, and it
offers a clear set of guidelines designed to reset the metabolism. Many
program-specific recipes are available, which helps keep the diet more
enjoyable—and that, in turn, helps people stick with it. The rules of the diet
are commonsense ones: Avoid sweeteners, alcohol, grains, legumes, dairy, and
food with preservatives. The best dietary goals are those changes you can
sustain long enough to see positive change yet have a short enough time
horizon that you can commit—thirty days is a good length. This is usually long
enough to allow the sugar cravings to clear. Once you detox from sugar, the
taste becomes too sweet and intolerable . . . imagine that! This is when you
know you have kicked the sugar habit. Many of my patients choose to stay on
the diet for longer periods of time, making it their daily eating plan.
One easy-to-find food that supports proper yeast balance is cold-pressed
virgin coconut oil, which has a high concentration of caprylic acid, an antifun-
gal. Ingest one to two tablespoons (14 to 28 g) per day at room temperature.
Coconut oil can be taken on an ongoing basis. For a more potent effect, you can
add one or two drops of oregano oil9 or turmeric oil,10 but do this only for one
to two weeks. Ingesting essential oils can be therapeutic but is appropriate
only for a short course of treatment; take the oils for no more than two weeks
at a time, with extensive breaks in between. Be sure to consult with a practi-
tioner trained in herbalism, aromatherapy, or the medical use of essential oils.
For a list of antifungal supplements to combat yeast overgrowth, together
with dosing instructions, see the reference chart on page 232.
Implementing Detoxification
in Daily Life
Toxins can create stagnation in the terrain of your body; just as the earth is
the terrain you walk on, your body is the terrain you live within. We all see the
effects of toxins and the overabundance of waste on the earth, but this also
happens within the body, with the same ill effects. The body has a harder time
clearing infections and toxins when it’s overly burdened by toxins, stress
hormones, infections, and unhealthy foods.
The ability of a person to clear toxins rests in genetics, lifestyle choices,
emotional stress, level of infection, and continued exposure to external toxins.
The good news is that we have the power to make changes and improve our
health over time. Chronic illness can be disempowering, but it does not have to
be. Making positive changes in your life is one area that you can control. Even
one good habit can change whole pathways, especially those regarding detoxifi-
cation, cellular growth, revitalization, epigenetics, weight loss, and pain. It takes
patience to allow changes to manifest in the physical body if toxins have built up

over years. This is where the commitment to daily positive choices is critical;
only by repeating a good habit does it become just the way you live.
Your body is a highly intelligent, efficient vehicle with the ability to heal
itself. This ability can be stifled, however, when an overabundance of toxins
builds up. Here, I will try to narrow the wide topic of detoxification to the top
priorities: These are the changes that will lead to a cleaner life. It may take
some time to implement the changes and reap the rewards, but think of your
improved lifestyle as a long-term solution—feeding your body with proper
nutrition, practicing mindfulness techniques, and committing to exercise can
turn on genes that bring you to optimal health.
I T ’ S N OT E A S Y B E I N G G R E E N —
B U T I T ’ S T H E B E S T CO LO R TO B E
You can dramatically reduce your exposure to toxins by taking matters into
your own hands and becoming more aware of green living. Take a moment and
look under your kitchen sink. Do you see products that make you cough and
your eyes water when you use them? Time to let them go because those
chemicals are being absorbed by your lungs and are moving into your circula-
tory system. Look in your cabinets. Are you using nonstick cookware or
microwavable plastics? Plastics can get into the food you eat and into your
body, mimicking estrogens. Do you have a water filtration system? New
parents strive to reduce chemical exposure for their babies, but why don’t we
continue to do this for ourselves as adults? Are we less precious? Following is a
summary of ways to green your life:
• Use green cleaning products. Eliminate, where possible, common

household chemicals such as cleansers, soaps, cosmetics, air
fresheners, and dryer sheets or replace them with substitutes that
are dye-free, biodegradable, and made from natural sources. Baking
soda, vinegar, borax, and lemon juice can work well for surface
cleaning. Or seek green-focused brands of cleansers and body
soaps, now widely available in the marketplace.
• Cook on the stovetop and in the oven, when possible. Don’t bake
or cook using nonstick cookware. Instead, use stainless steel, glass,
stoneware, ceramics, or cast-iron pans, when possible. Teflon flakes
off into your food as you cook in these nonstick pans, and it also
emits low levels of the toxin perfluorooctanoic acid (PFOA) as well
as other plastics. Microwaving in plastic containers releases
estrogen-like plastics into food, so avoid cooking or reheating food
in plastic containers. PFOA is released over time and is retained in
human tissues, increasing hormone-sensitive cancer risk as well.
• Quit smoking. You may feel that all the stress of treatment for
tick-borne infection makes this is the worst time to quit, but there
is never an easy time. Continuing to smoke while you are trying to
recover from tick-borne disease prolongs the illness because toxins
are coming in from the cigarettes, negating the work to treat the
infections. This is true of e-cigarettes and vaping tobacco, too.
• Consume clean, filtered water. Drink plenty of filtered water,
minimally sweetened with natural fruit juice if you need flavor.
Water is our primary element for life, so plentiful, clean water is
paramount to health.
Install a water filtration system if one is not already connected to your

plumbing or your refrigerator. Many water filtration systems exist, and they
vary in affordability and their ability to clear metal, microbes, chlorinated
by-products, volatile organic compounds, and radioactive substances from the
water (especially if you have well water). If an integrated system is outside
your budget, there are inexpensive options such as pitchers that filter water
and can be refilled and kept in the fridge.
You can have your water quality tested, which is especially important with
well water. If you have been chronically ill since moving into a new residence,
be sure to have your water professionally tested. Many patients are shocked to
learn how many toxins are in the water in their home, and their health
dramatically improves when the water issue is addressed.
• Eat ethically raised, organic meat. Be mindful of where your

meat comes from and how it is raised and processed. Ideally, meat
should have no added hormones or antibiotics. Livestock are fed
antibiotics to counter the illnesses brought on by the large doses of
hormones the animals are given to make them grow faster. When-
ever possible, buy local through farm-share programs and be aware
of whether the farm you purchase from adheres to humane
practices. This is not just about the ethics of the company but about
the quality of the meat. When animals are treated inhumanely, the
fat content is unhealthy; animals under stress release stress
hormones that are expressed in meat, which we then ingest.
• Avoid genetically modified foods. These are foods that have had
their genetics modified in labs, with the idea of producing bigger
yields, making the crops more resistant to insect infestation, and
developing prettier fruit. However, the changes to the genes of the
plants are altering the DNA of our gut flora and producing foods
that do not give our bodies the same nutritional value.

Clean Eating:
Get Savvy about Produce
Eat organic as much as you can afford to. Pay special attention to the fruits and
vegetables that are least and most likely to have pesticide residue. Some
vegetables and fruits are so saturated that no amount of washing will improve
your toxic load. The list below, created annually by the Environmental Working
Group, is an amazing resource for consumer rights helping identify the Clean
Fifteen, those which are the least impacted by pesticide residue, and those
which are heavily sprayed (the Dirty Dozen). You can get away with less
concern buying conventional produce with the clean fifteen. Check the PLU
number associated with the produce. The conventional produce with pesticides
will be a four digit number from 3000 to 4000. The certified organic produce is
a five-digit number starting with a 9. The genetically modified food is a five-
digit number that starts with an 8. The list is updated periodically, so search
online to confirm the most recent findings (Environmental Working Group
[www.ewg.org]).
CLEAN FIFTEEN DIRTY DOZEN

Least likely to have Highly concentrated
pesticide residue with pesticides
Sweet corn Strawberries
Avocados Spinach
Pineapples Nectarines
Cabbage Apples
Onions Peaches
Frozen sweet peas Celery
Papayas Grapes
Asparagus Pears
Mangoes Cherries
Eggplant Tomatoes
Honeydew Sweet bell peppers
Kiwifruit Potatoes
Cantaloupe
Cauliflower
Grapefruit
Skin Brushing
The skin is the largest organ in the body, and it continuously breathes in and out
like an external lung. Physical therapies such as saunas and dry skin brushing
can help this organ detox more efficiently. You can easily find a skin brush in the
bath and body section of any store. Before your shower in the morning, take a
skin brush and make light to medium brush strokes starting at your feet and
moving up to your torso; then brush from the tips of your fingers up your arms
toward your chest. This sloughs off excess skin cells and makes respiration
easier for the skin; it also detoxes by stimulating lymph fluid to remove wastes
from the system. An abundance of lesions on the skin, such as acne, can be a
sign that the skin is getting bogged down, trying detox beyond its ability.
• Clear the air. Air purifiers vary in their ability to filter airborne
microbes and toxins, and the cost will reflect the ability of the
system to remove microparticles from the air as well the noise level
of the machine. Many options are available, but start by researching
IQAir filtration systems; you can then compare what best works for
your home and budget.
• Remove electronics from your body and your nightstand.
Turn off your cell phone at night, and do not use it as an alarm
clock. Electromagnetic waves, even the low-frequency ones
emitted by cell phones, can cause changes to tissue function over
time. Use the speaker phone feature to keep the phone away from
your head. Do not wear the phone in your bra, front or back
pockets around the pelvic region, or anywhere on your body for
long periods of time. For the same reason that cells phones are
problematic, remove wireless routers from your bedroom or areas
where you spend a lot of time.
TAKE A DEEP BREATH AND CARRY ON

Our lungs eliminate excess carbon dioxide and hydrogens, which maintains
pH balance in the blood. Other than our outer layer of skin, the respiratory
tract represents our first lines of defense against toxins. Air quality is import-
ant, but so is the quality of our breathing. Many people (including me) have
developed a habit of breathing in the upper aspects of our lungs instead of

deeply from the diaphragm. This can start due to
stress and then become habitual; you may not even
The more deeply realize you’re doing it. Shallower breaths restrict
we breathe, the oxygen flow and release of toxins.
more we release Breathing, fortunately, can be corrected with
yoga training, mindfulness practices, meditation,
wastes and
and exercise. The more deeply we breathe, the more
reduce the toxic we release wastes and reduce the toxic effects of
effects of stress stress on our bodies. Oxygen therapies—including
on our bodies. hyperbaric oxygen tanks, intravenous ozone, and
oxygen delivered via nasal cannula through
portable systems—are sometimes used as a form of treatment for tick-borne
disease as well.
LOV E YO U R L I V E R
The most important organs to support for detoxification are the liver and the
digestive tract. The liver has the all-important role of distinguishing nutrients
from toxins in the foods we ingest. It converts carbohydrates, fats, and sugars
into useful forms of energy for the body, and it tags toxins to be eliminated.
The liver is made up of hepatocytes, cells that have an amazing ability to
regenerate and heal. In fact, you can remove a good portion of the liver and it
has the capacity to grow back! As the liver tags toxins to leave the body, they
are sent to the digestive tract and kidneys for removal.
Focus especially on enhancing detoxification of the digestive tract and
liver by avoiding foods that trigger inflammation, hydrating properly with
filtered water, moving your body with yoga and other exercise, and taking
herbal supplements that expel toxins. Another option is to participate in
routine fasts in the spring and fall. If you have no experience with fasting,
make sure to do so with medical assistance. Fasting typically should not be
considered during times of active treatment for tick-borne disease, as success-
ful treatment requires food to support the absorption of medications.
One of the main treatment goals is to help the liver cells in moving toxins
through movement of bile, which flows through the caverns between each liver
cell and picks up debris to dump into the intestines for removal from the body. You
can support your liver and digestive system with castor oil packs, bitter greens,
coffee enemas, and herbal formulations. As a culture, we have lost our love for and
tolerance of bitter tastes, since they cannot compete with the enjoyment that salty,
sweet, umami (savory), and sour flavors bring us. Introduce bitters back into
your diet with leafy greens such as dandelion, arugula, endive, radicchio,
watercress, and mustard greens. The bitterness can be cut slightly by blanch-
ing the greens, or by adding spices or acid in form of vinegars or lemon juice.
An old formulation, used since the early 1700s in Europe, is Swedish
Bitters, made up of seven ingredients: aloe, rhubarb, saffron, myrrh, gentian,
zedoary, and agarikon.11 Bitters improve neurological stimulation of the
digestive tract and promote proper digestion and mechanical release of bile
from the gallbladder.12 They also can be used to treat other conditions of the
intestines, including parasitic infections, fungal infections, water retention,
and inflammation. The intensity of flavor varies depending on the bitter herb
you use, and this intensity can determine the effectiveness in treating the
complaint.13 Consult with a practitioner trained in herbalism to understand
the type of bitter that would be best for your constitution; because of their
ability to stimulate digestion, bitters may not be the right choice if you have
inflammation in the digestive tract, reflux, or ulcerations.
Dandelion, a potent bitter edible plant, is generally regarded as safe for
most people, unless they are allergic to ragweed or daisies. Most people want
to pull up dandelions when they see them in the yard, but it’s becoming
common to see these vitamin-packed greens and roots in bunches in the
produce aisle. Dandelion is beneficial to our bodies because of its antiviral
properties; it also improves fatigue, decreases inflammation,14 purifies the
blood, and has been shown to have healing effects, restoring the cellular
function of diseased liver tissue.
Glutathione is an antioxidant made up of the proteins glutamine, glycine,
and cysteine. An important detoxifier and immune modulator, glutathione is
found in highest concentration in the liver. It neutralizes toxins in the human
body, supports mitochondria that create cellular energy, maintains healthy
vitamin C levels, and moves heavy metals, especially mercury, out of the soft
tissue of the body.15 This powerful antioxidant is depleted with continued
exposure to toxins such as alcohol, medications, trauma, infections, and heavy
metals. A deficiency of glutathione can increase toxins such as ammonia,
which increases neuroinflammation.
Glutathione can be supplemented orally, nebulized into the lungs, and
delivered intravenously. The preferred route is intravenous or nebulization,
but the oral liposomal glutathiones are improving in their absorbability. This
supplement is commonly used to mitigate neurological symptoms related to
multiple sclerosis, Parkinson’s disease, and heavy metal chelation, and to
reduce the impact of the Herxheimer reaction.
Binders such as bentonite clay, activated charcoal, modified citrus pectin,
aloe vera leaf, and psyllium husk absorb or grab on to toxins in the gastrointes-
tinal tract so they are eliminated rather than absorbed, and these are com-
monly used in treatment to reduce toxins in the body. These usually come in a
powder form—simply add one-quarter to one-half teaspoon to six to eight
ounces (120 to 235 ml) of filtered water. Typically, this is followed with

Detoxification Potential
of Coconut Oil
SUPPLEMENTING WITH VIRGIN COCONUT OIL has been shown to improve
antioxidant potential by enhancing glutathione production and superoxide
dismutase levels. Coconut oil has the ability to improve liver enzyme levels as
well.16 Readily available in grocery stores, coconut oil can be taken daily; one to
two tablespoons (14 to 28 g) per day is the optimal dose, but start with one
teaspoon and build toward the higher amounts. You can simply swallow a
spoonful or you can add it to coffee or tea, stir it into oatmeal, or spoon it into
yogurt. Coconut oil also ideal for cooking—it has a high smoke point, which
means it can be heated to high temperatures without creating harmful trans fats.
A common Ayurvedic practice called oil pulling entails swishing coconut oil
in the mouth for ten to fifteen minutes daily, which pulls toxins and has been
shown in studies to improve oral health.
another glass of plain water. Binders are best taken at least one hour before or
two hours after other medications because they are not selective in what they
bind. This could lead to lower absorption of supplements and other medica-
tions, reducing efficacy.
For a list of supplements, see “Common Herbs and Nutrients Used for
Detoxification Support” on page 224.
Supporting the Body

with Antimicrobial Herbs
Plant-based medicine is not just about the chemical constituents of the
plant—it’s not like taking a prescription—it’s about the vitality of the plant
resonating with the needs of the human to heal. According to herbalist
Matthew Wood in The Book of Herbal Wisdom: Using Plants as Medicines, we
are inviting a “magical experience” when we work with plant medicine.
Historically, shamans and herbalists have learned about the medicinal
properties of plants by communicating in meditative states with the con-
sciousness of the plant to learn how they can benefit humanity.
Plants inhabited the earth approximately five hundred million years ago,
whereas the earliest human remains that have been found are approximately
2.8 million years old. Plants have a deeper relationship with the earth and
have had more time to perfect their ability to survive. They have been our
food, shelter, and medicine, and they maintain the air we breathe. Plants are at
the roots of conventional pharmacology; many active ingredients synthesized
in modern pharmaceuticals were originally isolated from plants. They are also
conscious beings with the ability to communicate with one other, to learn, and
to respond to our emotional cues.
Herbal antimicrobials can be just as aggressive as antibiotics and, like
antibiotics, can produce a Herxheimer reaction. Many patients have learned this
the hard way, underestimating the power of plants and thinking they would get
through treatment faster if they took higher doses. Patients are often surprised
at just how powerful the herbs can be. Once patients clear some of the infection
from their body and build up strength, they may later use antibiotics as needed.
Herbal antimicrobials are the most frequently administered and asked
about therapies in my office. Because of the persistence of Borrelia burgdorferi
and other tick-borne infections, antimicrobials are important to the healing
process. These can be used alone or in conjunction with antibiotics. Many
patients elect to use only natural antimicrobials, based on their individual
comfort level, belief system, and concerns about past adverse reactions to
antibiotics. I always support this choice fully. In many cases, I also elect to
start with herbal antimicrobials alone if the patient is too weak to handle
antibiotics. Antibiotics many be added later if symptoms persist.
Typically, regimens consist of herbal tinctures; the concentrated liquid
form makes it easier for a patient to find optimal dosing. Dosing depends on
the herb and on the patient’s specific needs. While many blends are commer-
cially available, I also make specialty herbal blends in the office, as needed. For
those patients apprehensive about experiencing a Herxheimer reaction,
tinctures give more control; the dose can be modified up or down, depending
on response. Patients start with one drop per day added to two to four ounces
(60 to 120 ml) of water, and increase that by one drop every three to four days,
as the patient can tolerate without experiencing symptoms flares. Some
individuals are very sensitive to antimicrobials, and must start by adding one
drop to two ounces (60 ml) of water but drinking only one ounce (28 ml) of the
water, thus taking half a drop. Others may take only one drop every two or
three days. For those who are really reactive, I suggest that they rub a drop
into their skin or add a few drops to a bath. For most herbal antimicrobials, the
maximum dose is thirty to forty drops per day in two to four ounces (60 to
120 ml) of water. Starting with one drop per day, it takes a long time to
gradually work up to thirty drops per day.

The most common method of administration for herbal medications are
liquid preparations in combination formulas; in these formulas, several plant
extracts are mixed together for their synergistic and additive effect. Typically,
when mixing herbal extracts on your own, choose three to five plants that will
be beneficial, based on your treatment goals. If you do not feel comfortable
mixing your own, please use them individually or consult a practitioner
trained in herbalism. The following companies are those I use most often in
my practice: Byron White Formulas, Beyond Balance, LymeCore Botanicals,
Bio-Botanical Research, Herb Pharm, Nutramedix, Elk Mountain Herbs,
Chinese Classics, Misty Meadows, Wise Woman Herbals, and Gaia Herbs.
A diversified antimicrobial protocol can increase the likelihood that the
medications will get into hard-to-reach tissues and work with more than one
organ system for a better outcome. Both natural and conventional antimicro-
bials have the capacity to create a healing crisis with a Herxheimer reaction.
The main difference with herbal antimicrobials is that you have more control
over the amount taken.
For a list of supplements used for antimicrobial purposes, see the chart
“Antimicrobial Herbs” on page 225 and “Essential Oils with Antimicrobial
Properties” on page 232 . The list of antimicrobial herbs is vast, and there are
many options beyond the ones I’ve included, but those I list have been well
documented for their antimicrobial properties. This list is meant as a refer-
ence; please contact a practitioner trained in herbal medicine to help find the
best option for your needs and constitution. Natural medicine is not a one-
size-fits-all process; instead, it’s a wide open, creative experience with many
options.
Biofilm Busters
The goal in reducing biofilm is to access the microbes within the biofilm and
make antimicrobial medications more effective. Biofilm is built by bacteria to
help them withstand host immunity and changes in pH, and to create for the
bacteria an environment in the body that is hospitable to their survival.
It is best to take a biofilm-busting supplement on an empty stomach and to
avoid eating for two hours after ingesting it, alternating two weeks on
supplements and two weeks off. Start with a low dose of one capsule initially
because gastrointestinal upset may occur due to several bacterial and fungal
microbes that live within the digestive tract. Side effects such as bloating and
diarrhea or constipation may occur as the microbiome rebalances. If a patient
has a history of small intestinal bacterial overgrowth, taking biofilm busters
may aggravate those symptoms if they are not resolved. Get advice from a
medical practitioner before starting on a biofilm buster.
In Combating Biofilms: Why Your Antibiotics and Antifungals Fail, James
Schaller, M.D., suggests that it would be therapeutically beneficial to combine
more than one biofilm buster and pulse the dosing. It’s difficult to ascertain
dosages for this, as the data are all over the place in terms of whether a high
dose or minimal dose is more effective; also, enzymes historically have
different units for dosage, depending on the brand. Whichever supplement you
purchase, follow the instructions on the bottle—most formulas suggest one to
two capsules twice per day. If you are working with a natural medicine
provider, review the formulation and dosing instructions.
For a list of supplements used to fight biofilm, see the chart “Biofilm-
Inhibiting Herbs and Nutrients” in the reference section on page 227.
Supporting the Adrenal Glands

We live in bodies that still function as though it were thousands of years ago,
with primitive mechanisms for adapting to stress. The fight-or-flight response
is designed to help us get away from a life-threatening situation. Historically,
we faced dangers such as being chased by wild animals, starving, contracting
disease, and being exposed to extreme elements, and our defenses are cali-
brated to cope with those threats. Now, our defense mechanisms are commonly
triggered by things such as noise pollution, financial stress, annoyances,
trauma, and being overworked. The past wasn’t easy living by any means, but in
modern times we face a great deal more stimuli. We are plugged in to technol-
ogy for most of our waking hours, have a faster pace of life, and pack more
activities into a day—all this can drain energy from the adrenal glands.
The adrenal glands rest atop the kidneys and are responsible for many
metabolic functions such as immunity, adaptation, regular sleep cycles,
cardiovascular balance, digestive balance, and blood sugar regulation. The
adrenals are made up of the outer cortex and inner medullary. The outer
cortex is further divided into layers that produce aldosterone, cortisol, and
dehydroepiandrosterone (DHEA). The adrenal hormone system is intimately
entwined with the nervous system.
The adrenal glands are constantly communicating with the hypothalamus
and pituitary gland in the brain to maintain hormone balance as changes in
the outer environment affect the inner environment of the body. Think, for
example, about driving a car. A lot of sensory data is coming in continuously
when you are on the road, and as long as the drive is uneventful, you probably

feel calm. Then a person cuts you off, and you are jolted out of autopilot into a
state where you need to react quickly to stay safe. Adrenaline is expressed
from the adrenals, enhancing vision, bringing more blood to your muscles,
increasing respiration to get more oxygen to muscles, and increasing your
heart rate. When the situation is over, you notice that it takes time to feel
normal again. The ability to get back to baseline is different for every
individual. A person with a healthy, minimally stressed pair of adrenal glands
will return to baseline fairly quickly. A person suffering from an illness, or one
with a high-stress personality or a history of trauma, will have a more difficult
time recovering.
When the body is stressed due to internal or external demands (think of
the traffic aggravation I mentioned above), the adrenal glands will respond
based on chemical messages from the brain, depending on the psyche’s
interpretation of the stressor. This can be good stressor, such as a celebration,
or a negative stressor, such as a fear response. Each one triggers a response
from the adrenal glands, and this response helps maintain multitasking,
sustained energy, and quick thinking.
As negative stressors are prolonged during chronic illness, the adrenals try
to help us survive. Beneficial adrenal hormones such as cortisol and DHEA are
reduced due to the adrenals’ inability to express enough to keep up with
demand. Cortisol and DHEA help reduce the negative effects of prolonged
adrenaline release, causing inflammation and blood sugar dysregulation.
When cortisol and DHEA are both low, the person has increased symptoms of
chronic fatigue, pain, weight gain around the middle, poor wound healing, and
irregular sleep patterns, often with feelings of exhaustion because of continued
insomnia. He may also have a tendency toward low blood pressure due to
improper sodium and potassium balance regulated by the adrenals.
Adrenal fatigue contributes to female hormone dysregulation due to low
cortisol levels. These low levels force the body to borrow from progesterone
stores to make more cortisol, leading to progesterone dysregulation. Proges-
terone deficiency leads to shorter female cycles and irregular bleeding
patterns. For most Lyme disease patients, both women and men, progesterone,
estrogen, DHEA, and testosterone levels should be checked. We all have the
same hormones, though appropriate levels are gender specific. Most of my
patients have some form of hormone dysregulation due to stress and
prolonged illness.
Hormone levels can be corrected over time with medication and, ulti-
mately, by resolving the source of stress. The hormone imbalance may have
started at an early age as the glands were maturing; cortisol levels can even be
disrupted during a stressful birth. Many patients have suffered a traumatic
childhood event or were not given adequate nurturing in a stressful home
environment. Correcting the hormone imbalance may require a combination
of herbal remedies, bioidentical hormone replacement (if needed), mindful-
ness practices, and trauma work.
Every patient in my practice is evaluated for adrenal function, which can
usually be determined based on history of illness, sleep schedule, energy level,
and metabolism, as well as evaluation of sex hormones. Those with low
adrenal function also tend to experience a pattern of sugar cravings or
sleepiness in the afternoon, around 1 to 3 p.m., with a surge of energy at 5 to
6 p.m. It can easily be treated with herbal support, B vitamins, homeopathic
remedies, DHEA supplementation, and regularity in sleep schedule. The
adrenal glands crave regular schedules.
For additional information on supplements to support the adrenal glands,
see the chart “Adrenal-Supportive Herbs and Nutrients” on page 227.
Supporting the Body with

Natural Anti-inflammatories
Changing the course of inflammation in the body is one of the areas where
natural medicine shines. Through dietary changes, herbal support, and
supplementing heathy omega 3/6/9 anti-inflammatory oils (fish oil and borage
oil, for example), inflammation can be reduced in the body, changing the
pathways that cause pain and degeneration. Treatment of inflammation is
about striking a balance between pro-inflammatory and anti-inflammatory
pathways. Without inflammation, our bodies would not be able to heal
properly, as inflammation helps protect the body, clear toxins, and kill
invaders. However, chronic Lyme disease triggers inflammatory proteins to be
expressed over and over again, which weakens tissues over time. It also
creates chronic relapsing pain in multiple areas of the body.
The immune cells primarily responsible for inflammation are cytokines.
Cytokines are produced by several immune cells in the body in response to
stressors—those cytokines most frequently seen in Lyme disease are IL-6,
IL-8, and TNF-_. Lyme disease spirochetes cross the blood-brain barrier,
triggering cytokines and promoting inflammation. The presence of these
proteins can trigger cells to attack myelin sheaths (the protective fatty layer
around nerves) and also enhances oxidative damage, mitochondrial dysfunc-
tion, and antibodies that attack the neurological tissue.
Some cytokines are anti-inflammatory, but Borrelia burgdorferi suppresses
this pathway in the body. The continuous triggering of pro-inflammatory

Mast Cell Activation
Syndrome
MAST CELL ACTIVATION SYNDROME (MCAS) is a constellation of symptoms
that present as hives, abdominal pain, flushing of the skin, numbness, tingling,
cognitive disorders, and more severe manifestations such as anaphylactic
reaction. Anaphylaxis can lead to low blood pressure and loss of consciousness.
Reactions often necessitate a trip to the hospital for emergency intervention.
MCAS can develop with or without tick-borne infection as a trigger and is
confirmed with symptoms history, specific blood markers, and urine markers.
Mast cells are immune cells found throughout connective tissue in the body;
they release histamine in response to stress, which creates inflammation and
swelling in the area. Identifying the trigger can be difficult, which is very
stressful for patients because the response can happen out of nowhere.
The treatments for MCAS are similar to those for tick-borne infection and are
designed to reduce inflammation and detoxify the system. MCAS is a complex
condition that requires care from those trained to treat it.
cytokines can create autoimmune-like symptoms and elevate inflammation

markers in the blood associated with autoimmune disease.
Even when infection is present, autoimmune disease can be triggered. As
the body tries to manage the imbalance of pro-inflammatory cytokines and
clear a hard-to-reach infection deep in the tissue, the body attacks itself. Self
attacking self is the very definition of autoimmune activation.
Combatting Neuroinflammation
and Providing Cognition Support
When Lyme disease colonizes multiple areas of the body simultaneously,
including the brain, it creates inflammation that impairs memory, causes
brain fog, and creates mood imbalances, which can lead to extreme changes
in personality, altered speech, abnormal gait, sensory overload, and auto-
nomic dysfunction. This colonization of Lyme disease in the brain can also
cause a person to feel separate from himself, a phenomenon called deperson-
alization, and it can inhibit activities of daily living, disrupt sleep patterns,
and increase pain.
Note that this constellation of symptoms is based on the number of
neurotoxins circulating in the brain and the activation of neuroglial cells, a
large group of cells that surround neurons and “glue” everything together.
Glial cells are free-floating cells in the central nervous system. In the brain,
they monitor and react to changes in the brain environment, and their
importance in brain healing and regeneration can’t be understated. They
maintain proper neurotransmission, energy metabolism in the brain, and
overall brain balance, and they ensure the integrity of the blood-brain barrier.
In particular, brain microglia (a type of glial cell) are the primary immune
defense in the brain. However, microglia that are continually in a state of
overstimulation called microglial activation can, over time, become part of the
problem rather than the solution. Microglia are important to synaptic pruning
of unnecessary neurons, tissue repair, and the scavenging of plaques and
microbes that can cause injury to the brain. They are responsive to inflamma-
tion, which can be caused by leftover fragments of Borrelia burgdorferi in the
brain. This debris can be present after anti-infective treatments.
Interestingly, a 2018 study titled “Primary Human Microglia Are Phago-
cytically Active and Respond to Borrelia burgdorferi with Upregulation of
Chemokines and Cytokines,” published in Frontiers of Microbiology, found that
human microglial cells, which function to ingest harmful substances in the
brain, only absorb B. burgdorferi fragments killed by antibiotics, not those that
are living. The living microbes are out in plain sight, but microglial cells are
not triggered to clear them out. Only when B. burgdorferi exists as leftover
dead fragments do the cells react. Much more research is needed to under-
stand this response fully.
Natural medications have been helpful in improving neurocognitive
function. They can help balance neurofeedback pathways in the body, improve
blood flow to the brain, and support proper gut health because of the gut-brain
connection. The beneficial microbes living in our small and large intestine
participate in the regulation of neurotransmitters—mainly serotonin and
gamma-aminobutyric acid (GABA)—via a communication pathway that uses the
vagus nerve. This pathway is the primary communication between the brain
and the gut, also known as the second brain, or the enteric nervous system.
The vagus nerve governs the parasympathetic nervous system, which
stimulates cellular repair by supporting proper sleep patterns, healthy
digestion, adaptation to stress, and an overall sense of calm. When we are
calm, we seem to go through life more comfortably. Unfortunately, we often
spend far too much time triggering the opposing system, the sympathetic

nervous system. This system stimulates the fight-or-flight response, which
creates the burst of energy you need to get through stressful situations. If this
response is triggered too much, though, it can degrade the body’s immune
system and cause more inflammation. One of the simplest—and cheapest—
ways to support your vagus nerve is through meditation (we’ll explore the
vagus nerve and the nervous systems more in chapter 10, when I discuss living
with chronic Lyme disease).
One of the major pathways altered by inflammation when Lyme spiro-
chetes invade is the one that produces serotonin, referred to as the kynurenine
pathway. Serotonin is the amino acid that improves mood, helps regulate sleep,
and maintains energy, libido, and appetite—in fact, many antianxiety medica-
tions and antidepressants attempt to make more serotonin available by
blocking it from leaving the brain. A nonmedication option for maintaining a
healthy balance of neurotransmitters is to feed the brain the amino acids it
needs to make the neurotransmitters such as 5-HTP and L-tryptophan, which
are precursors to serotonin.
N-methyl-D-aspartate (NMDA) receptors are triggered by glutamate.
Glutamate is one of the most abundant neurotransmitters in the body, used to
send signals from one nerve cell to the next. It is also extremely important in
cellular repair, neuroplasticity, learning, and cognitive function. Injury to the
brain in the form of acute trauma or chronic afflictions such as chronic Lyme
disease makes it more difficult for glial cells to maintain the proper amount of
glutamate in the brain, leading to overabundance.
As discussed previously, the biggest problem with having chronic Lyme
disease is the perpetuation of inflammation cycles that age the body prema-
turely. Over time, inflammation markers are released in response to the
presence of spirochetes in the brain. This can cause memory loss, learning
impairment, psychological imbalance, and eventually brain injury. The most
common inflammatory protein responsible for toxicity in the brain is quino-
linic acid, which builds up in the brain as a result of overactive glial cells.
Elevated levels of quinolinic acid have been found in blood serum and
cerebrospinal fluid of those confirmed with B. burgdorferi.17
Herbs that have been shown to reduce neuroinflammation include
curcumin/turmeric, Gastrodia, ginseng, ginkgo, green tea extract, licorice
root, and Uncaria rhynchophylla.18 Preliminary research has also shown that
supplementing with the serotonin precursors L-tryptophan and 5-HTP can
reduce neuroinflammation. Gluten-containing foods, on the other hand,
contribute to the abnormal stimulation of NMDA receptors, which can explain
the brain fog people experience after eating a piece of bread. Serotonin
depletion can lead to increased cravings for sweets. It’s best to feed the brain
in a way that creates healthy serotonin flow throughout the day and to
King, Prince, Pauper
WHEN YOUR SEROTONIN LEVELS ARE LOW, you may crave sugary, unhealthy
carbohydrates such as cookies, cakes, and soda; but these foods will only set the
stage for more inflammation, blood sugar imbalance, and growth of yeast in the
system. Serotonin precursors have a natural rhythm—they are more heavily
expressed later in the day, as they participate in the sleep cycle.
The best plan for supporting healthy serotonin levels is to eat meals in order
of king, prince, and pauper: Make breakfast the largest meal of the day; eat a
midsize meal lighter in protein in the middle of the day; and have the lightest
meal—consisting mainly of complex carbohydrates such as vegetables and
fruits, healthy grains (quinoa, wild rice), and a small amount of protein—at the
end of the day. The standard American diet typically involves little or no
breakfast because we are in a rush and a heavy, protein-dense meal at night
because we are ravenous after a long day. Flipping this pattern can help reduce
weight and improve mood balance throughout the day as we better align with
our bodies’ natural neurohormone cycles.
supplement with the serotonin precursors listed above. Other supportive

choices are regular exercise, light therapies used for seasonal affective
disorders, and a diet rich in eggs, chickpeas, raw cacao, chicken, turkey,
salmon, beef, and nut butters.
As much as we might prefer to manage our bodies naturally, for mood
imbalances that are severe or caused by overwhelming life stressors, prescrip-
tion medications may be necessary. My advice is to stay open to all therapeutic
options, including pharmaceuticals, as the situation demands. Unfortunately,
some patients associate antianxiety medications with being mentally or
emotionally weak, or they fear they will become reliant on the medication.
These are valid concerns, but if you are experiencing intense anxiety or sleep
deprivation due to neuroinflammation, the priority is to calm the nervous
system so it can heal.
For a list of supplements and herbs used to fight inflammation, see the chart
“Natural Anti-inflammatories for Brain and Body” on page 228. These supple-
ments can be taken with food and with other medications, with the exception
of the proteolytic enzymes, which are best taken on an empty stomach at least
an hour before eating again. If these enzymes are taken with food, they will use
their action to break down the food instead of being absorbed into the digestive

lining for therapeutic benefit. Note that you do not need to buy all of these
supplements individually. Many natural anti-inflammatories appear in
combination products that simplify the process of incorporating the herbs into
your treatment. Those anti-inflammatories that are cooking herbs, such as
curcumin, can simply be used more liberally in foods for their benefits.
In Summary
If you have a primary care doctor or Lyme-literate physician who has
provided prescription medications but offered limited guidance on natural
medications to support the process, the supplements discussed in this chapter
and listed in the reference section at the back of the book will provide you
with much-needed information. If cost is an issue or if you find this list
overwhelming, I recommend prioritizing a high-dose probiotic (no matter the
antimicrobial protocol), a detoxification supplement, adrenal support, and
herbal antimicrobials.
The quality of the supplement is very important. Let the buyer beware
when it comes to websites with supplements from third-party sellers, for there
is no guarantee the product is authentic or that it was not tampered with or
stored improperly. These supplements are the foundation that support your
health, so take the time to learn how they work and what they can do for you.
Seek medical guidance to tailor the most efficient medication combination for
your health goals.
CHAPTER 8
THE
FOUNDATION
IS STRONG—
NOW
SUPPORT
THE
INFRASTRUCTURE
he therapies discussed in this chapter can serve as robust support for
T the body throughout the healing process. While the treatments we

talked about in the previous chapter help create a solid foundation
for conquering tick-borne diseases, you need to do more than build
a foundation—you need to support the infrastructure so that you have greater
energy, mobility, and well-being, and stronger immunity. Here, you’ll find sim-
ple, accessible options for doing that, from homeopathy to flower essences to
essential oils—all of which support the mental, emotional, and physical body.
The Premise of
Homeopathic Medicine
Outlined in the early nineteenth-century book Organon of Medicine by
Samuel Hahnemann, M.D., homeopathy is a system of medicine based on the
151
Law of Similars. The premise is that giving small doses of a physical sub-
stance that causes symptoms in larger doses heals those same symptoms. In
a homeopathic dilution, the substance can be mineral, plant, medication,
animal, or microbe. Diluting the substance enhances the potency of the
energies for healing purposes and avoids the negative effects of the physical
substance. It provides the body with the information needed to change its
circumstances. The medication delivered is in such small amounts that it’s
no longer physically present in the carrier substance (usually water, alcohol,
or sugar pellets).
This was a difficult concept for me when I first started in my naturopathic
doctorate program, but after studying the topic intensively for two years in
medical school, relying on my own experience, and observing the amazing
changes in patients over a decade, I have found homeopathy invaluable. While
it may sound impossible for the dilution to be medically useful, homeopathy
represents a form of quantum healing. The energetic imprint of the substance
remains in the liquid dilution or pellets. This dilution primarily changes our
water, a majority of our physical substance. You can get a better understanding
of water’s ability to change its form with new information by reading a book
by Masaru Emoto, doctor of alternative medicine, such as The Hidden Mes-
sages in Water or Love Thyself.
Miasms
Dr. Hahnemann noticed that each patient presented with a particular
constitution, temperament, physical characteristics, likes and dislikes, and
family patterns, which he referred to as miasms. Miasms are imprints or
tendencies within a person, and they create a predisposition to certain
diseases. These are passed down through the generations in families. If a
family was exposed to a certain disease during an epidemic, for example, that
exposure could change genealogical history if not fully resolved with healing
of the mind, body, or soul; this may manifest on an individual level as things
you are attracted to or dislike.
Miasms may influence the environments in which you feel at peace or in
conflict, your aversions and attractions, and the time of day you are most alert.
If your tendencies create stress on your body and mind, your health can be
affected. This can weaken your immune system, hormone system, and
neurological system. Miasms can play a role in disease states and how you
might manifest them. A unique constellation for every person, miasms are
both conscious and unconscious.
We all have miasms on some level, but healing happens when we develop a
deeper understanding of our inherited baggage and let it transform into new
patterns, which can heal your current life as well as the lives of your descen-
dants. If energy blockages, inner emotional conflicts, trauma, and unhealthy
family patterns persist over time, however, they can cause disease states.
The amount of data collected and categorized in homeopathic references is
immense, and a full exploration is beyond the scope of this book. This infor-
mation has been collected over two centuries by many practitioners who
witnessed consistent outcomes after dosing people with certain substances;
they then documented the mental, emotional, and physical changes. My goal is
to familiarize you with the concepts surrounding homeopathy, as the thera-
pies are so widely available. A form of therapy rooted in individualized
medicine, homeopathy is something I use daily in my practice to help patients
in healing many conditions. I have found it can be implemented with other
therapies, even conventional medications. I was trained in constitutional
homeopathy. In this branch of homeopathy, we identify a specific remedy after
taking a detailed patient history and comparing it with detailed data on
remedies collected by practitioners for a few hundred years.
I frequently use homeopathic nosode therapy and homeopathic drainage.
Homeopathic nosodes are highly diluted preparations of dead microbes such
as the bacteria that cause tick-borne infections, viruses, parasites, or funguses.
To be clear, there are no active infections in a nosode remedy; they are
energetic imprints that provide the body with the information it needs to
overcome symptoms. Homeopathic drainage uses combinations of minerals
and botanicals to help with the clearing of toxins; these formulations, which
are geared to specific organ systems, help patients regain healthy organ
function and energy. Consult with a naturopathic doctor or practitioner with a
professional certification in homeopathy to find the right formulation for your
particular health condition.
Low-Dose Immunotherapy
Low-dose immunotherapy (LDI), developed by Ty Vincent, M.D., expanded
on low-dose allergy therapy, which has been used for decades to expose the
body to very low doses of a substance known to cause allergy, whether that is
a food, medication, microbe, or an environmental factor. The therapy is
intended to retrain the body to ignore these harmless substances. Dr.
Vincent borrowed from this treatment concept, expanding it by using
dilutions of infectious diseases, primarily tick-borne infections. The
T H E F O U N DAT I O N I S S T R O N G — N OW S U P P O R T T H E I N F R A S T R U C T U R E 153
therapeutic value is in exposing the body to diluted amounts of infectious
diseases, which changes the body’s response to one of tolerance rather than
of reaction. The microbial immunotherapy dilute is typically paired with the
enzyme beta-glucuronidase, further enhancing the treatment’s effectiveness
in shifting the immune response. In my experience, the medications can also
be effective without this added enzyme, which is the way I typically dose it
in my office.
If tick-borne disease and other microbes can persist in the body even
with treatment, then LDI offers an option that helps the body be at peace
with the presence of the microbe. As I’ve discussed previously, the most
problematic issue with Lyme disease, as well as other persistent microbes in
the body, is triggering of the immune response, which creates persistent
inflammation, causing tissue damage and suffering. LDI changes the
behavior of the immune cells so they are no longer in attack mode. According
to Dr. Vincent, LDI enhances the function of the T suppressor cells, which
calms the response that leads to many autoimmune conditions. I have seen
good results with LDI, leading to both immediate and continuous improve-
ment as patients return for treatment at regular intervals. I have seen higher
energy, reduced headaches, less ringing in the ears, lower light sensitivity,
and decreased pain.
LDI remedies are created with dead microbes acquired from a specialty
lab. No live infections are ever used. These dead microbes provide informa-
tion in the same way that homeopathic remedies do, via leftover proteins,
which are then diluted with sterile water. Through this process, solutions
with different potencies are created from the mother tincture. These can be
administered as a subcutaneous shot with a small bubble of liquid placed
under the skin or sublingually (under the tongue) for those who prefer oral
dosing to a shot. The immunotherapy shots are affordable compared with
other therapies and require administration approximately every two
months. LDI can be used as a primary therapy or in combination with
other treatments.
As with any therapy, when the treatment works, it works well. While not
everyone is responsive, I feel it’s worth trying. The remedies have many
different dilutions, so it’s possible to tailor the specific dose to the individual.
My interest in offering LDI as a treatment in my clinic was piqued because
my primary patient population is infected with tick-borne disease and tends
to be willing to try new therapies if they might enhance quality of life. I have
seen symptoms improve, together with lab values that show a higher anti-
body level on the Western blot as well as the CD-57, in patients using only
LDI. These positive outcomes depend on the individual’s immune system, but
LDI is a promising form of therapy for the rising number of people with
chronic infections.
Flower Essences
Think about being near a flower, with its vivid color and sweet scent, and you
can feel your mood lift. You are connecting with the essence of the plant using
your sense organs, both your physical sense organs and subtle senses of
intuition, to connect with the remedy. Flower essence remedies are based on
formulations brought forward by Edward Bach, M.D., homeopath, bacteriolo-
gist, general family physician, and researcher in the 1930s. A very intuitive
doctor, he connected the emotional imbalance in patients with an appropriate
expression of support from the plant realm, specifically flowers. Dr. Bach
started with a list of 38 remedies, and other practitioners have since expanded
this list. As with homeopathy, the data have been collected by many practi-
tioners over time, as they repeatedly observed patient outcomes. Flower
essences can be researched further by visiting the websites of such organiza-
tions as the Bach Centre (www.bachcentre.com) and Green Hope Farms
(www.greenhopeessences.com) or by reading one of the many books on the topic.
The flower essences support the emotional body through life challenges.
Homeopathy works on the level of the physical body as well as the mental-
emotional body. Homeopathic remedies are made in levels of varying potency,
while flower essences imbue their energy signature into the water itself as the
flower parts steep in water. Flower essences can be taken internally, applied
externally, used in baths, or sprinkled on food. I recommend them frequently
to help calm patients’ anxieties, improve mood and sleep quality, and support
them through emotional traumas. You can start by simply selecting a flower
essence that corresponds to an issue you want to address and adding five drops
of the essence to your water bottle, then drinking as you normally would
throughout the day.
Electrolytes
As simple as it sounds, electrolytes offer great benefit to counter adrenal
fatigue and autonomic dysfunction in those with chronic tick-borne infection.
It’s important to supplement with electrolytes when a person with tick-borne
disease has symptoms of fatigue, postural orthostatic hypotension (a drop in
blood pressure upon standing), lightheadedness, frequent fainting spells,
persistent sweating, and muscle spasms. Chronic infections deplete the body
of electrolytes, making it more difficult to maintain balanced hormones and
neurological function and adapt to stressors, thus leading to symptoms
associated with autonomic dysfunction.
Vitamin D Supplementation
VITAMIN D TESTING IS BECOMING MORE COMMON as part of routine annual blood
work. Its clinical relevance and dosing have been underemphasized due to
several decades of fear surrounding the toxic effects of vitamin D excess. In
Great Britain after World War II, too much vitamin D was added to milk products,
with ill effects on infants and toddlers. At that time, it was commonly added in
large doses to milk and cereal and was even marketed as enhancing the health
effects of beer because it was known to prevent rickets, a bone-weakening
disorder that causes bowing of the legs, delayed growth, and body pain. These
high doses created body pain, nausea, and vomiting, discovered to be due to
vitamin D toxicity. The backlash led to the belief that anything more than what
would be found in a tablespoon of cod liver oil—about 400–800 IU—could
potentially be toxic.
Vitamin D is delivered primarily by ultraviolet light, when the skin is exposed
to sunlight. It is then converted in the kidneys to its physiological form and helps
in the absorption of key minerals for bone development.1 Food sources of
vitamin D include meat, fish, fortified foods, and cod liver oil.
It is important to supplement with the vitamin D3 form rather than the D2
form. The common prescription form of vitamin D is vitamin D2, the plant form,
but the human body has to do further work to convert it to the animal form, D3.
A typical dosage can range from 1,000 IU daily to 50,000 IU of vitamin D3 once
weekly. Dosing is variable because of differing opinions among practitioners.
The most common doses are 5,000 IU daily or 50,000 IU once a week. Proper
dosing is dependent on whether vitamin D is being given for maintenance or to
normalize dramatically low serum levels. The optimal level for this vitamin is
60–70 ng/ml; however, many Lyme disease patients suffer from low vitamin D,
in the 30 ng/ml range.
The relationship of vitamin D deficiency and susceptibility to infection has
been well documented for almost a century, but research shows that chronic
bacterial infections can lower serum vitamin D levels by upregulating inflamma-
tion markers that downregulate vitamin D receptor genes. 2 Other viral infections
can also lower vitamin D receptor activity, including Epstein-Barr3 and Mycobac-
terium species.4 To stay current on vitamin D research, visit the website of the
Vitamin D Council (www.vitamindcouncil.org).
In those with chronic Lyme disease, the adrenals are low functioning, which
is a problem because they manage the balance between sodium and potassium
in the body. When electrolytes are depleted, the body has a difficult time with
fluid balance, causing dehydration, cardiovascular instability, low blood
pressure, muscle weakness, sleep disturbance, and neurological disruption. If
you are tired and are drinking water but never feel hydrated, this could be an
indication that you have adrenal fatigue leading to electrolyte imbalance.
Water follows the electrolytes in the body. When a person is trying to
avoid heatstroke in intense heat, he will often take salt tablets (sodium is an
electrolyte) to help hold in water. Lowering salt intake, on the other hand, can
reduce water retention. Proper water and mineral balance are important to
our daily functioning.
To add electrolytes, you can stir electrolyte powder into water (follow
package instructions) and consume it throughout the day, or you can drink one
of the many prepared waters infused with electrolyte supplements. I caution
against using conventional replenishment drinks that have high sugar content
and are colored with dyes. If you are blasting your hormone system with sugar
and chemicals, you are defeating the purpose of adding electrolytes, which is
elevating health. Keep your electrolyte products simple and choose those with
minimal ingredients beyond the minerals themselves. This is true for any
supplement purchased in the marketplace. If the “other ingredients” list on
the bottle shows more ingredients than are on the minerals list, put the
supplement back on the shelf.
Intravenous (IV) Therapy

In medical school, my primary focus was training in the use of intravenous
(IV) therapy, and I concentrated on environmental medicine, the study of
toxic burden on the body and of how to relieve this burden so the body can
return to healthy function. I was also interested in the immune-enhancing
ability that IV therapy could deliver to support the body’s fight against cancer
and infections. IV therapy is administration of liquid substances—vitamins,
minerals, chelation agents, amino acids, or electrolytes—directly into a vein.
IV therapy can allow a substance into the body at therapeutic doses that could
not be taken orally. For instance, vitamin C (ascorbic acid) can only be ingested
at doses of perhaps 3–4 g orally before the digestive system decides that’s
enough and the rest is eliminated; at these lower levels, vitamin C is an antioxi-
dant, reducing the cellular damage from toxins and enhancing immune function.
When used intravenously, vitamin C can be taken in amounts of 50–60 g, at which
point it becomes pro-oxidative in a way that is helpful for fighting infection and
cancer. At this dose, vitamin C increases the body’s production of hydrogen
peroxide, which is its method of killing bacteria, funguses, and abnormal cells.
IV therapy has also been useful in cases where digestive problems lead to
malabsorption of nutrients, in infections such as mononucleosis, and as a
means of detoxing harmful substances from the body. The most common IV
treatments I use are vitamin/mineral combinations, chelation agents (eth-
ylenediaminetetraacetic acid [EDTA], dimercaptosuccinic acid [DMPS]),
glutathione, high-dose vitamin C, and hydration. These work beautifully as a
stand-alone therapy for acute conditions or as an adjunct therapy in case of
chronic illness.
Pain Relief
Pain management is at a critical place right now, due in part to the opioid
crisis. The health care system is trying to discourage use of pain medications
that may spiral out of control and help those who are taking pain control
medications in a destructive way while at the same time providing robust pain
management to individuals who truly need it. With tick-borne disease
treatment, pain is one of the most common complaints, but it is difficult to
address. Far too often, chronic Lyme disease patients who have debilitating
nerve, joint, and muscle pain are denied treatment for pain because the
seriousness of the chronic disease is not acknowledged.
Leaving people in chronic pain creates trauma and desperation and often
leads patients to self-medicate, sometimes in harmful ways. They may obtain
addictive substances illegally and potentially abuse these drugs, which only
creates another illness to recover from. Many patients have reported using
excessive amounts of alcohol, high-dose anti-inflammatories, sleeping pills,
and illicit drugs just to find relief. Most had asked their doctor for help and
been turned away. Unresolved debilitating pain is one reason patients with
tick-borne disease make frequent trips to the emergency room.
Pain management is a complex topic because so many variables contribute
to the experience of pain. Many techniques can reduce pain through mindful-
ness exercises and the therapeutic application of acupuncture. In addition,
medicinal herbs such as cannabis—now legal in some states—offer a safer
alternative for those whose pain remains at high levels. States where cannabis
is decriminalized are also experiencing decreasing opioid use. I have seen a
huge difference in patients who are able to use cannabis without fear of legal
penalties. They report reduced use of NSAIDs, sleeping pills, and antianxiety
medications, as well as improved well-being. As patients feel more stable,
resume quality sleep, and reduce their pain levels, they are able to be more
compliant with their medication regimen and recover with greater efficiency.
Eventually, they are weaned from medications and are able to live their lives
free of pain.
Cannabis
CANNABIDIOL (CBD), DERIVED FROM CANNABIS SATIVA , is a nonpsychoactive
constituent of the plant (tetrahydrocannabinol [THC] is the psychoactive constit-
uent). CBD and THC are similar in molecular configuration but act very differently.
The reason we humans react as we do to cannabis is that we already make our own
cannabinoids through the endocannabinoid system, which acts in many different
tissues in the body to maintain balance immunologically and neurologically.
THC has been indicated for reducing nerve pain, reducing muscle spasticity,
improving cognition and digestion, and reducing anxiety. It modifies inflammation
by activating CB2 receptors on immune cells. CBD is thought to subdue or block
the response of cannabinoid receptors in our brains—specifically CB1, where it
does not actually fit into a receptor but links to the side of the protein to decrease
the function of the receptor. The fact that it does not go directly into the receptor,
as THC does, is the reason CBD products do not produce a high. CBD also has a
higher affinity for CB1 receptors in the neurons, which is why CBD offers greater
benefit for seizure-like activity. CB1 receptors are found primarily in the nervous
system, whereas CB2 receptors are linked with the immune system.
CBD and THC, when ingested, lose a lot of their potency through the
digestive process—on average, only 6 percent is bioavailable. 5 These products
are available in many forms, including as oil, capsules, dried (for smoking), and
made into edibles such as chocolate squares and gummies. The most common
options among my patients are oil blends and gummies. I can legally only
dispense CBD. THC products are regulated by formal dispensaries across the
country, depending on state laws. Dosing is difficult to discuss because there
are so many different formulations, plant species (Cannabis sativa, Cannabis
indica, Cannabis ruderalis), and patient-specific needs. Talk with your medical
provider if you are looking to integrate cannabis into your treatment plan so you
can find the best combination and dosage for your needs.
Mitochondrial Support
Mitochondria are the power generators of the cell. If mitochondria are not in
good health, it is difficult for the body to remain well. A unique aspect of our
physiology, mitochondria developed a symbiotic relationship within the
human body; they are actually distinct living entities. While they did not
originate from us, over millions of years mitochondria have become a part of
us. All cells have varying levels of mitochondria within them, depending on
their function and energy needs. Their primary role is to make adenosine
triphosphate (ATP), which functions as our cells’ fuel.
Like other parts of the human body, mitochon-
dria can get overwhelmed with infections and toxins,
Like other which reduces their energy output. As this happens
parts of the on a wider scale with systemic illness, cellular repair
human body, mechanisms and energy are depleted and the aging
process is accelerated. Mitochondrial dysfunction
mitochondria
can be either genetic or acquired through diseases
can get over- that affect organ systems, including the cardiovascu-
whelmed with lar, neurological, musculoskeletal, and digestive
infections and systems. Most individuals with mitochondrial
dysfunction are affected by acquired dysfunction.
toxins, which
The good news is that, with detoxification and
reduces their proper nutrients, mitochondria can recover.
energy output. I also suggest having a “dialogue” with mitochon-
dria, visualizing them as strong, healthy, and
restored. This is best done during meditation or before you take a supportive
supplement. The body and its inhabitants are highly responsive to intention.
Supportive nutrients that feed your mitochondria include:6
• Alpha lipoic acid: Antioxidant, anti-inflammatory, detoxifies

mitochondria, reduces cytokines, and enhances glutathione. Dosing
is commonly 200–600 mg daily.
• L-carnitine: Helps transport healthy fatty acids into the cellular
membrane for proper function. Affinity for cardiovascular cells,
antiaging support, and energy enhancement. Dosing up to 2,000 mg
per day shown safe.
• CoQ10: Antioxidant, especially with oxidative damage of the
neurological system. Upregulates gene sequences for metabolism
and detoxification. Depleted with statin medications. Improves
endurance. Dosing up to 1,200 mg per day.
• NADH/NAD+: Improves cognitive dysfunction found in neurode-
generative disorders. Improves chronic fatigue. Improves attention.
Dosing can be 5–20 mg; there are also nasal sprays available on the
market for enhanced absorption.
• Membrane phospholipids: Replace damaged mitochondrial
membranes. Symptoms improved associated with chronic fatigue
and fibromyalgia. Dosage varies depending on product. Can come in
powdered, liquid, or capsule.
Essential Oils
In terms of treatments that are easy to find, are simple to apply, and yield real
results, essential oils make the grade. For tick-borne disease, essential oils can
act as antimicrobials, reduce stress, support a healthy immune system, and
reduce symptoms associated with inflammation, including pain. They are also
very helpful during minor acute illnesses such as upper respiratory infections
and can serve as antiseptics for minor wounds.
The impact of essential oils on emotions is also well established, and they
can be helpful in calming people with issues such as post-traumatic stress
disorder and other stress-related conditions. In one study, lavender infused
into the air of a designated nursing area of a trauma intensive care unit was
shown to reduce stress among the nurses, potentially leading to improved
retention and job satisfaction.7
The journal Frontiers in Medicine published a study that looked at 34
popular essential oils and their effects on Borrelia burgdorferi in the petri dish.
Researchers found that oregano, clove bud, and cinnamon bark offered the
greatest antimicrobial effects against B. burgdorferi and hindered biofilm
formation at the lowest concentration. Oregano oil has the most potent effect,
due to its active ingredient, carvacrol, which works to hinder both spirochete
growth and biofilm formation. Bergamot has also shown great promise in
inhibiting spirochete growth.8
Essential oils can be used in blends or individually. Eucalyptus, for
example, can be mixed with myrrh to reduce inflammation and act as an
antimicrobial. Add a little clove to combat throbbing sensations and add
chamomile for a calming effect and to reduce nerve pain. Essential oils can be
added to baths, applied topically with proper dilution, expressed into the air
with diffusers, or used in massage therapy and Reiki sessions to enhance the
therapeutic experience.
When deciding on an essential oil, note that not all oils are free of toxins—
chemicals may be used to extract the oils from plants, and these chemicals are
retained in the oils you are applying to your skin or, potentially, ingesting.
Quality is important; not all oils are created equal. When choosing a supplier,
make sure the company uses pure, organic botanicals and that it employs
regular testing to ensure it is meeting quality standards. There will be some
natural variability of the active ingredients in the oils, depending on the
location where the plants were harvested and on the weather conditions the
season they were grown.
While it has become popular to ingest oils for daily health maintenance,
this is not historically how they were used. When I studied medicine, I was
trained in the use of essential oils. They should only be ingested short term
and should be managed by a provider with extensive training with herbal
medications and aromatherapy. Peppermint oil, as one example, should not be
consumed on a daily basis, as recommended by some, because the oil disturbs
microflora, data on the long-term effects for internal use are limited, and it
can be irritating to the sensitive tissues of the digestive tract. The essential oil
is very different from a breath mint!
Essential oils can be administered in the following ways:
• Topically: Oils used topically should be mixed with a carrier oil,

such as sweet almond oil or olive oil. You can keep the mix in a
small bottle with a dropper or in a roll-on bottle. Apply the oils, as
needed, to the affected area, such as an area of tension on the neck.
Before using on a larger surface area of the body, perform a spot
test by rubbing oil onto a small area of the arm and waiting an hour
to check for a reaction. Some oils, such as citrus and bergamot, can
cause photosensitivity or skin irritation. Oils can also be added to
an Epsom salt bath for pain relief—it only takes a few drops.
The dilutions below are typically added to a carrier oil such as
almond oil, olive oil, or castor oil and used topically. Just about any
oil is safe to use as a carrier for external application.
Percent Dilution Drops per 1 oz (30 ml) Use
2 percent dilution 10–12 Aromatherapy
3 percent dilution 15–18 For pain
25 percent dilution 125 Super strength
• Aromatically: Oils placed in a diffuser can spread their antimicro-

bial effects over a large area. Diffusing antibacterial and antiviral
oils throughout the house is especially helpful during cold and flu
season. Adding a few drops of oils to a facial steam bath can kick
out a sinus infection very effectively. Diffusion can balance moods
such as depression or anxiety as well. When oils are inhaled, they
go straight to the areas of the brain that control emotions.
• Internally: I do not suggest internal use of essential oils on a

regular basis, but in some circumstances taking oils orally can be
useful. Black cumin seed oil and oregano oil are both useful
anti-inflammatories that can be taken internally for short periods
of time under the guidance of a trained practitioner.
For further study of essential oils, refer to The Complete Book of Essential
Oils and Aromatherapy by Valerie Ann Worwood or Releasing Emotional
Patterns with Essential Oils, 2018 edition, by Carolyn L. Mein, D.C. Avoid
references written by essential oil companies, as the information may be
skewed. Once you have your reference and your oils, have fun! Get to know
them, and see how they make you feel. Generally, if it makes you feel good, it’s
an oil your body wants. If the oil stops smelling good to you, that may be an
indication it’s no longer needed. Each of the oils has a different personality, and
the more you use them, the more familiar you will become with their properties.
For more information on therapeutic essential oils, see the chart “Essential
Oils with Antimicrobial Properties” on page 232.
In Summary
These natural remedies can all be integrated into your treatment protocol for
tick-borne disease, and you should investigate and experiment to see which
ones resonate with you. Homeopathy and flower essences are best used with
assistance from a medical practitioner because we are not always able to see
ourselves or those we love clearly when it comes to self-prescribing. Supple-
ments recommended for mitochondrial support are easily acquired and simple
to use: Just follow the recommended dosing instructions on the packaging.
The use of cannabis for pain management does require assistance, in my
opinion, to assess the appropriate brands, strengths, and THC/CBD combina-
tions, and for advice on how to implement it for the best outcome. You may get
lucky and find the perfect dose for you, but most patients who buy CBD oil on
their own get poor results and then abandon it altogether.
Just knowing these treatments are available options is enough to get you
discussing them with your medical practitioners. For more detailed data, visit
the reference guide at the end of this book.
CHAPTER 9
BUILDING
YOUR
FUTURE
BODY:
PHYSICAL
MEDICINE
hysical medicine uses movement, mechanical stimulation, heat,
P manipulation, and/or electrical stimulation instead of medications to

heal the physical body. These techniques enhance strength, improve
neuroplasticity, and mechanically move bacteria out of hiding with
improved circulation. This is why physical medicine is important to the treat-
ment of chronic Lyme disease, no matter how minimal the approach. When
we are inactive due to fatigue, pain, instability, vertigo, and/or depression, we
can age prematurely, and this leads to a reduction in flexibility and fluidity and
thus a lower quality of life.
Many patients come to the clinic after years of chronic illness and immo-
bility. They frequently complain of a lack of flexibility and increased cracking
sounds in their joints. Recovery requires reinforcing strength in the body.
Think of it as building the body of the future by changing from the inside out
and the outside in. One of my professors in medical school, Dickson Thom,
D.D.S., N.D., used to say it took three to five years to fully change a human
body—that is the time it takes to heal completely and reverse tissue damage.
I feel this is also the time it takes to rewire the mind and to see the changes in
164
the mind create changes in the tissue. Healing can be
immediate, but realistically, we need to incorporate
particular habits of movement, eating, thinking, and
Even with
breathing to regain and maintain the health we seek. limitations,
The energy propelling this will be willpower, inten- being at peace
tion, and hope.
with our body
Treatments will have different outcomes,
depending on an individual’s genetics, temperament,
and in healthy
lifestyle choices, and health status. Our bodies are relationship to it
beautiful vehicles that give us the opportunity to is a critical part
move about the earth, interact with others, and
of getting well.
accomplish tasks that give meaning to our lives.
Sometimes, the body may want to just sit and be still, which is important too;
but the ability to move our bodies freely and with vigor is one of our greatest
gifts. Even with limitations, being at peace with our body and in healthy
relationship to it is a critical part of getting well.
This chapter addresses the importance of physical medicine modalities
that can support restoration as you recover. I am not trained in the use of
acupuncture, massage therapy, or craniosacral work, but I’m discussing them
here because I know they are valuable methods with plenty of data and
positive patient outcomes to support their validity. Naturopathic doctors are
trained in making adjustments to the musculoskeletal system, just as chiro-
practors and osteopathic practitioners are, as part of the degree program.
Some choose to make this the focal point of their practice, while others home
in on other specialties. Naturopathic doctors are also trained in minor surgery,
but many practitioners are unable to perform procedures, depending on
whether the state in which they practice allows minor surgery as part of the
scope of practice. The same is true for chiropractic adjustment.
Physical medicine is not just about exercise therapeutics; it encompasses
mechanical support for alignment of bones, muscle flexibility, and reduction
in localized areas of pain, as well as subtler options such as craniosacral work.
Exercise in some form is necessary if your recovery is to be wholly successful;
it also reduces the amount of physical therapy you require after you have your
strength back. Many patients lose confidence that their bodies will be able to
do what they want them to do or they experience negative consequences, such
as debilitating fatigue, after exercise. Some patients who exercise during
recovery have increased Herxheimer reactions, and this can be a deterrent to
further exercise.
Chronic Lyme disease can change the consistency and production of
collagen fibers, which can alter the healing process of connective tissue—mus-
cles, fascia, tendons, and ligaments. The presence of spirochetes and other
165
tick-borne infections cause inflammation, altering the balance of hyaluronic
acid (which lubricates tissues) and ground substance (a gel-like substance in
extracellular spaces), and this changes the process of wound healing.1 Acute
injury and inflammation initially swell tissue, and chronic inflammation over
time can atrophy or dry out ligaments, joint capsules, and other connective
tissues, creating reduced mobility, weakness, and pain. Exercise, even light
movement, lubricates and hydrates tissues, bringing in more nutrients while
removing toxins. Supplementing with collagen type I/III or bone broth with
also support healthy ligaments, tendons, and joint capsules.
All physical modalities can bring greater awareness of the places we are
holding on to tension in our bodies, create consciousness of the emotions
needed to release this tension, and remove hindrances in the body that are
causing discomfort. For maximum benefit, find an activity or treatment
modality that attracts you, one that draws you to receive the therapy. Have
realistic goals and work from a place of detachment, remaining open to
whatever changes begin to happen. Your therapy may transform you in
amazing ways you would not expect, but you could miss these marvelous
effects if you are looking for a different outcome.
Exercise and Physical Therapy

One of the most frequent questions I am asked is whether I recommend
exercise to Lyme disease patients. I have heard many different opinions on
this matter from other practitioners, and my answer is that recovery is an
individual process and that patients must be evaluated on a case-by-case basis
to determine how much exercise they can accommodate while recovering. It
depends, in part, on what the person was doing before he got sick.
If you are used to running marathons and have the endurance to run ten
miles per day, you may need to scale back to five miles per day or less. If you
were never one to exercise, this is not the time to start training for a triathlon.
That may seem to be common sense, but I’ve had patients who wanted to show
that Lyme disease was not going to get the better of them, and they chose to
start a new intense workout regimen with an unrealistic fitness goal. When
they can’t accomplish it, they end up in bed, hurting and demoralized.
Being sick with a chronic disease requires that you tune in to yourself and
know your limits. But it is not an excuse to avoid life. You may need to modify
your normal pursuits for a period of time, but do your best to engage daily in
something active. Make sure it is an activity you enjoy, to remind yourself that
you are not your diagnosis. If you get stuck in the story of your limitations,
they can become a self-fulfilling prophecy. This is a delicate balance of
listening to your body while also pushing it to maintain endurance and
strength. Start small, keep showing up, and give your body time to heal.
Moderation is the healthiest option in just about every situation.
B U T F I R S T, YO G A
Yoga in the form of yin yoga, yoga nidra, or restorative yoga is an easy place to
start with exercise—these types are all about going inward. Yoga nidra is done
while lying on the floor in a pose referred to as the corpse pose while being led
through guided meditation to release tension held in the body. Yin yoga
incorporates postures with fluidity and no expectation of precision, with
postures held for gradually longer periods of time. Its primary focus is to go
inward and indulge in the stretch, being as fluid as you wish and learning to
allow the muscle to relax.
Yoga is essentially a system of balancing the breath and the posture to
lengthen and strengthen the body, over time opening the flow of energy through
breathwork and inviting the muscles to respond by becoming more relaxed.
Through regular practice, you can become stronger within your core muscles or
the postural muscle groups deeper in the body. There is also the enormous
benefit of improved diaphragmatic breathing and quieting of the mind through
meditative movement. Yoga studios will have a variety of practices, with Hatha
yoga seeming to be the most accessible. Yoga was originally meant to enhance
the ability of a spiritual initiate to sit comfortably and meditate for several
hours. Over time, it has become a daily practice that keeps a person connected
to self and helps the body stay flexible through the aging process. Yoga has
also been used to reach higher states of bliss through controlled breathing
techniques and movements, such as those practiced in Kundalini yoga.
M OV E M E N T, R E S I S TA N C E T R A I N I N G ,
A N D W E I G H T- B E A R I N G E X E R C I S E
The most important part of any physical modality is discipline. Your chief
responsibility is to keep showing up to your own daily regimen and to see your
physical medicine practitioners, if that is something you can afford and
integrate into your life. Many patients end up debilitated to the point that they
are unable to drive, which makes it difficult for them to get to medical visits on
a regular basis. Lyme disease symptoms that change from day to day, or even
from moment to moment, also make integrating activity into daily life compli-
cated. The goal is to integrate some kind of movement, even if that means
beginning with simple exercise at home. Start with five to ten minutes per day
and build over time—keep showing up for yourself. Go outside for a short walk;
exercise your lower or upper body while lying on the floor or sitting in a chair if
B U I L D I N G YO U R F U T U R E B O DY: P H Y S I C A L M E D I C I N E 167
you feel standing is not safe. Even integrating a habit
of stretching in bed, if that is all you can do, will help
Exercise is not you maintain some flexibility. But exercise is not just
just about the about the physical movement; it’s about empower-
physical movement and motivation. It creates optimism and uplifts
mood. I also suggest some form of massage, physical
ment; it’s about
therapy, and/or chiropractic care at least twice per
empowerment month. For the best outcome, add these modes of
and motivation. therapy to your daily exercise routine.
It creates A study published in 2015 in Medicine and Science
in Sports and Exercise looked at the effects of resistance
optimism and
training on patients suffering from chronic Lyme
uplifts mood. disease and found that, after a routine of three sessions
per week for four weeks, patients reported improved
energy levels and showed measurable improvement with exercise performance.
The specific exercises were primarily varying repetitions of the leg press, seated
row, vertical chest press, standing heel raise, and supine abdominal crunch. 2
Weight-bearing exercise, accomplished by strapping on wrist or ankle
weights and walking around the house performing normal activities, can add
muscle mass. Typical weights for this type of exercise are one to three pounds
(455 g to 1.4 kg). You can also lift weights using low-impact handheld weights in
the one- to five-pound range (455 g to 2.3 kg). After several repetitions, that
one-pound (455 g) weight can feel like a brick. Repeat your exercises until you
feel a slight burn and shake in the muscle. This should be slightly uncomfortable,
like you are working the muscle, but you should not feel intense pain. Please stop
if you experience serious discomfort or pain. Work with your doctor and physical
therapist to create a regimen that is appropriate for your health limitations. The
idea is to increase your strength and ultimately overcome those limitations.
Q I G O N G A N D TA I C H I
Qigong and Tai Chi are gentle meditative modalities that have been clinically
shown to reduce pain, are safe in their application, and are benign in their
slow, controlled movements. Qigong dates back more than 5,000 years; though
it is a movement modality, it is also related to Traditional Chinese Medicine,
which I will discuss in the next section. Qi (Chi) means “vital energy for the
body,” and gong refers to a disciplined practice to achieve a higher level of
skill. Tai Chi was initially designed as a tool of defense in martial arts, but it
has also long been practiced for health effects, as it focuses on relieving the
physical impact of stress.
Both these forms of movement calm the nervous system by blending
movement, breathing, and meditation into a form of self-care, and both are
Stepping Up to Support
Those with Chronic Lyme
Disease: The Dean Center
IN NEW ENGLAND, WHERE MY PRACTICE IS LOCATED, a prestigious state-
of-the-art institution opened its doors to chronic Lyme disease patients,
exhibiting an attitude of nonjudgment and acceptance. The Dean Center for Tick
Borne Illness within Spaulding Rehabilitation Hospital, right in Boston, was the
first major institution for patients with tick-borne infection that provided
much-needed physical rehabilitation services and sought to learn about the
disease with the goal of changing the current medical model. Headed by David
Crandell, M.D., and Nevena Zubcevik, D.O., this department has been critical for
the morale of Lyme disease patients, who finally have acknowledgment and a
place to receive care. The facility is designed to serve a population who require
medically managed physical support to return to active and productive lives.
This is a facility to keep an eye on as it collects and analyzes data that could
change views of tick-borne disease from the inside out.
used to achieve optimal health and longevity. Movements are gentle and slow,
allowing anyone to participate. The more consistent you are with the practice,
the more aware you become of your own flow of energy and the relationship of
energy flowing through the natural world.
Over the centuries, many teachers have developed styles of Qigong and Tai
Chi practice, with movements related to those witnessed in the plant and
animal realm. These practitioners used movement for personal healing, to
harness healing energy so they can be of service to others, to achieve spiritual
enlightenment, to expand the strength potential of the body, and to manipu-
late subtle forces related to physical matter, which can look like magic to the
outward observer.
My personal experience is with Yi Ren Qigong, which I studied with
Guan-Cheng Sun, Ph.D., founder of the Institute of Qigong and Integrative
Medicine based in Washington State. Learning Qigong was so important in my
awareness of the relationship between mind, body, and spirit throughout my
healing journey; I use it regularly.
I commonly recommend Tai Chi and Qigong to my patients. Teachers of
Tai Chi are easy to find, but, depending on where you live, you might find it
more challenging to locate a Qigong practitioner. If you have access to a
teacher, all the better, but videos that introduce the practices are readily
available online.
As a medical practitioner, I feel safe advising patients to take up an activity
of slow and controlled movements that have little chance of causing injury. My
goal for my patients is to improve strength, body awareness, stability on their
feet, confidence in their physical ability, and gait. These benefits are especially
helpful for those who use walkers or canes for assistance. Devoting ten
minutes up to an hour a day can benefit you by increasing your confidence in
your physical strength, decreasing your stress and pain, and attuning you to
your inner awareness (intuition).
As integrative medicine becomes more accepted, additional research will
start popping up to validate its place in the healing arts. Qigong and Tai Chi
have been the subject of several research studies tracking their power to
improve quality of life, strength, and well-being. A study published in 2010 by
the American Journal of Health Promotion found improvement in those
practicing regular Qigong with regard to their cardiovascular health, bone
density, physical functioning, steadiness on the feet, self-efficacy, and quality
of life. 3 Bone density is usually increased through weight-bearing exercise;
however, Qigong is minimally weight bearing. Nonetheless, the patient
demographic of postmenopausal women showed an increase in bone density
and lower rate of fractures in those practicing Qigong regularly. Cardiopulmo-
nary function improved, high blood pressure dropped, and they improved
endurance with exercise. They also functioned better physically, experiencing
reduced pain and improved gait.
Healing with
Chinese Medicine
I’m not formally trained in acupuncture, cupping, or moxibustion, so I can’t
speak from a place of authority on the subject. However, I have worked closely
with acupuncturists in clinical practice, taken classes introducing Chinese
medicine concepts, received many treatments over the years, and witnessed
amazing outcomes with patients. I could not include a chapter on physical
medicine modalities without mentioning the elegant systems associated with
traditional Chinese medicine. It has been so important in my own healing
journey through Lyme disease, pregnancy, and postpartum care, and in other
times of need.
AC U P U N C T U R E
Acupuncture is one of the earliest forms of medicine, dating to around 100 BCE
and referenced in the text The Yellow Emperor’s Classic of Internal Medicine.
This system of medicine diagnoses and treats the body based on elements
found in nature that are the same as those found in the human body. By taking
a detailed history of the patient and performing tongue diagnosis and pulse
diagnosis, acupuncturists can identify areas of the body that are out of balance.
They then create a treatment plan that calls for specific needle placements
within the body to support the healthy flow of energy, referred to as Qi or Chi.
When the elements and temperaments are in balance, Qi flows freely and
supports optimal health through a system similar to the circulatory system. It’s
made of small channels called nadis, which make up the system that integrates
incoming Qi into the physical body. When there is stagnation in the movement
of Qi, disease can manifest, leading to pain, reduced organ function, chronic
infections, buildup of toxins, mood changes, and chronic fatigue.
Acupuncturists study for years to memorize the meridian system, which
took centuries to map. Meridians are pathways that run throughout the body,
and each of the meridians is related to certain organ systems. Meridians are
condensed lines of force running through the body from a collection of nadis.
Think of this in terms of the human circulatory system, where the capillaries
are the nadis and the meridians are the larger vessels the capillaries feed into.
The most common question patients ask about acupuncture is if the
needles are big and if they hurt. I have experienced minor discomfort during
acupuncture, but not because of the needles’ size—they are about the width of
a human hair—but because the imbalance in my system was responding to the
treatment. The acupuncture needle redirects stagnant energy so it flows more
freely to the organ system, thus improving the physical health of the organ as
well as any mental-emotional stagnation associated with the imbalance. In
acupuncture a physical needle is directed into the skin, but the energy it
impacts has implications for the mind, body, and soul.
For those with tick-borne disease, acupuncture can enhance the healing
process by reducing pain due to inflammation, improving detoxification,
healing injuries, stabilizing sleep patterns, and creating space for self-care.
Most insurance companies include coverage for acupuncture, and it is
becoming more integrated into the conventional medical model each day.
CUPPING
Another modality associated with traditional Chinese medicine is cupping, a
treatment in which small cauldron-like glass or soft plastic bulbs are placed on
the skin, creating suction. This therapy is used to improve microcirculation of
the capillaries, decrease toxins, and reduce tension and pain in the muscles.
The most popular method is dry cupping: A therapist puts a small amount of
methylated ethers or another flammable substance into a glass cup and ignites
it; when the flame goes out, he puts the cup upside down on the skin, creating
a vacuum inside the cup. Alternatively, plastic cups with a suction device
attached may be used to create a vacuum. Cups can be left in one place or
dragged over oiled tissue to loosen tension for a short period of time. Depend-
ing on the level of suction, there can be some discomfort, but good communi-
cation with your practitioner will allow him to apply an ideal force. Cupping is
another way of mobilizing stagnant blood flow and Qi energy flow in the body
to improve health. It’s enhanced when partnered with massage therapy.
Cupping gained sudden attention when, with the world watching, Michael
Phelps appeared on the pool deck at the Olympics with red rings on his body
that looked like bruises. This is a common outcome with cupping. The dark
lesion is related to the level of stagnation in the tissue where the cups were
applied. These marks are commonly not painful, as bruises are, but can look
ominous for a few days after treatment.
M OX I B U S T I O N
Moxibustion is the application of burning dried moxa (Artemisia vulgaris) on or
near the skin—smoke and heat emanate from the moxa much like from an
incense stick. Moxa is typically hovered above acupuncture meridian points to
stimulate the area and move stagnating energy. Its therapeutic benefit is related
to aromatherapy from the smoke, heat, and location of the application. Research
has validated the use of moxabustion to relieve irritable bowel syndrome,
hypertension, and pain-related issues, and to reduce symptoms associated with
cancer treatment, reduce swelling, and stimulate the immune system.4 It is
equally effective in treating pain and digestive issues and providing the immune
support required in patients suffering from tick-borne infection.
F LOTAT I O N T H E R A PY
Commonly referred to as flotation restricted environmental stimulation
technique (REST) or sensory deprivation therapy, this technique has been
around since the 1950s. The process involves lying face up in a quiet, darkened
pod filled with highly concentrated magnesium sulfate–saturated water. This
solution has a higher salt concentration than the Dead Sea, in which humans
are completely buoyant. One can relax each and every muscle in a solitary,
weightless state. Earplugs further reduce the intake of sensory information,
contributing to the sense of calm.
The sensory deprivation tank was initially developed by medical doctor
and neuropsychiatrist John Lilly in 1954. His studies focused on generating
altered states of consciousness when sight, sound, and touch were dramatically
diminished. This therapy has historically been more popular in Europe, but it
is popping up in the United States in alternative health clinics as a method of
relaxation, chronic disease management, and self-care.
Flotation REST therapy has been researched for several decades, mostly
looking at its application for treating trauma, managing pain, enhancing sleep
quality, and improving attention and cognition. It’s been helpful in reducing
pain from headaches, fibromyalgia, and premenstrual syndrome.
Researchers hypothesize that the pain-reducing effects arise from the
body’s naturally occurring endorphins, endocannabinoid system, and opioid
system, and from a reduction in stress hormones.5 Studies also show that the
treatment brings people into a sleep state in which their brain wave function is
equal to Sleep Stage 1, equivalent to a cat nap.6 In this sleep stage, alpha and
theta waves start to rise and changes in eye movement occur. Alpha waves are
associated with a relaxed and contemplative state of mind, while theta waves
bring you closer to the dreaming state, though you are still conscious. (Delta
waves are the ones associated with deep sleep.)
The theta state is one of deep relaxation, and it can enhance creativity and
the positive qualities of the right brain to put us more in tune with emotions,
the whole picture, and intuition, as well as compassionate thinking for self and
others. This enhanced right-brain activity creates more balance with the
left-brain analytical mind, which excels at linear thinking, and is outcome
driven and attached to time. Both hemispheres serve a purpose, and when the
two are well synchronized, we have greater potential for improved mental
health, increased neuroplasticity, and better overall mental processing. This
translates into better health of the body, with balanced endocrine function
and enhanced immunity.
Massage Therapy and

Musculoskeletal Manipulation
Many people think of massage therapy as an indulgence, and some are afraid to
get their bones adjusted. I can tell you that therapeutic touch can make an
enormous difference in your ability to heal, as it can aid in detoxifying, improve
blood flow to the brain, reduce stress, and improve the efficacy of medications.
One of the core symptoms in patients with tick-borne infections is pain.
This usually manifests as muscle pain or nerve pain, with reduced flexibility.
Some form of therapeutic touch is important to recovery, as it improves blood
circulation in the tissues. In fact, the connective tissues in your body, called
fascia, cover the muscles throughout your body and
work as a whole system. They communicate through
Some form Bonghan ducts, which transmit information in a
of therapeutic circulatory system independent of the blood or
touch is lymphatic circulatory systems.7 These channels send
signals to enhance tissue repair and development
important to
based on the needs of the body, and they have an
recovery, as it impact on connective tissue, muscles, bone, and
improves blood neurological tissue. Stagnation in the tissues creates
circulation in the perfect ground for infection and toxins, which
can certainly disrupt proper communication.
the tissues.
Massage helps improve the flow of communication,
since this circulatory system is promoted by movement of the tissues.
When a muscle holds tension due to a hypervigilant nervous system, this
tension restricts blood, creating an area of hypoxia (low-oxygen environment).
In this state of low oxygen, inflammation triggers muscles and nerves, causing
pain. This type of pain is referred to as myofascial pain syndrome and typically
manifests with a number of trigger points. These trigger points can refer pain
to outlying areas, making it difficult to know where the origin of the pain is.
As the tension stays in the muscle, the muscle will pull the bones out of
alignment, and this misalignment creates even more muscle pain. Compensa-
tion in the body can lead to imbalances in the right and left sides, as well as
problems with posture. Carrying pain in this way often leads to reduced
activity levels, which only feeds the cycle. Thus, bringing bones back into
alignment with a visit to a chiropractor, osteopathic physician, or naturo-
pathic doctor can be most beneficial.
The marriage of these two modalities is critical: If the underlying tension
in the muscle is not addressed with massage and you just receive adjustments,
muscle tension will keep pulling the bones out of place. However, if you only
treat with massage and an area continues to be a problem despite adequate
attention, you may require a realignment to allow the tension to release in the
muscle. At the core of all this is mitigating stress with mindfulness and
moderation in lifestyle choices, which can help prevent tension from accruing
in the first place.
Before moving on, let’s address the possibility of experiencing a Herx-
heimer reaction with both these hands-on treatments. The likelihood of this
response is because of the increase in blood flow, which liberates toxins and
disturbs pockets of tissue where spirochetes are making their home. As these
are released into the system, a flare or even a fever may follow. In my early
twenties, before I contracted Lyme disease, I went for my first deep tissue
massage. At the time, I lived in Los Angeles, where there were many places to
receive alternative healing therapies. A couple of hours after the massage was
over, I felt nauseated, with flulike symptoms, and had to stay home the next
day to recover. I saw this negatively then and never wanted to get a massage
again. However, I later learned this was normal and beneficial, and I was
happy those toxins I had been walking around with were gone.
Massage and bone adjustments vary in intensity based on the practitioner’s
training. Traditional massage sessions, sought for relaxation, are at one end of
the spectrum while at the other end are more intense forms, such as Rolfing.
Rolfing involves the massage therapist applying deep, slow-moving pressure to
break up the fascia sheaths around the muscles, as these become adhered and
calcified over time. Rolfing can bring about profound changes in posture, release
toxins, and release emotional memory held in the muscle. Emotional muscle
memory can manifest with any therapeutic touch, but it seems to be released
especially with Rolfing or other techniques that break up fascia. This can come
up as spontaneous release of emotion and flashes of memories. I won’t sugarcoat
it; it’s physically uncomfortable. But deep tissue work can be well worth it when
you feel ready; it can be beneficial in creating proper alignment in the body,
which decreases pain and improves internal organ function.
Craniosacral Work
Neurological impairments involving cognition, abnormal body movements,
visual changes, ringing in the ears, pressure in the head, and vertigo are all
common symptoms of Lyme disease that make daily life difficult for the
average patient. These symptoms can be due to impaired flow of cerebrospinal
fluid, which runs throughout the brain spaces and the spinal column in a
system considered a third circulatory system (the first two are those carrying
blood and lymphatic fluid).
The craniosacral system is devoted to cleansing, protecting, and nourishing
the organs of the central nervous system. This includes the brain, the covering
over the brain (the meninges), the spinal column, and the glial cells. When the
flow of cerebrospinal fluid is healthy, it moves through the deeper aspects of
the brain via a system of channels, washing over the surface of the brain and
down the column of the spinal cord. This fluid does not have the same velocity
as blood moving through the circulatory system but is affected by reverbera-
tions from the heartbeat. With stress, infection, inflammation, or head injury
(major or minor), the flow of cerebrospinal fluid can be disrupted.
Craniosacral work uses subtle touch and traction to feel areas of tension
associated with the fascia of the skull and spinal cord. The level of touch is
Sauna Therapy
HEAT THERAPIES ARE IDEAL FOR THOSE WHO CAN TOLERATE THEM. I
know many Lyme disease patients have a hard time in the heat and flat out don’t
like it. Sauna therapy, or therapeutic sweating, has been used in numerous
cultures for thousands of years for its health benefits, and it has ceremonial uses
and a social aspect as well. The sauna design most commonly seen today, with
the wooden walls and heated stone, has its origins in Finland. If you are purchas-
ing a sauna for your home, please make sure the wood is free of the toxins found
in treated wood, which would inevitably off-gas in the box and create more
toxins in your body.
Traditional saunas, heated with stones, raise the core body temperature to
create a feverlike response in the body, which clears toxins and enhances the
immune system’s ability to clear infections. The idea is to have a dry environ-
ment so heat can be maximally effective, since water on the skin has a cooling
effect. A steam room does not provide the same benefits and is actually a
breeding ground for pathogens. Ideally, the inside temperature is 110°F–160°F
(43°C–71°C)—most are around 120°F (49°C). If you have never tried a sauna
before, your initial sitting should be approximately five minutes. Bring plenty of
water to drink while in the sauna and continue to drink afterward to rehydrate.
Toxins will be emitted from your skin, and you will experience upregulating in
the enzyme pathway, triggered by heat.
A related therapy developed in Japan, called Waon therapy, uses a dry
sauna set at about 130°F (54°C) for ten to fifteen minutes followed by a
thirty-minute body wrap in heated blankets to maintain the internal body
temperature for the hyperthermic effects. 8 This process has been seen to
improve chronic fatigue, decrease pain associated with fibromyalgia, improve
depressed moods, and improve hypertension. 9 Waon therapy is similar to hot
fomentation, a hydrotherapy treatment that also involves wrapping a patient
with layers of sheets, wool blankets, and hot packs to increase the core body
temperature and clear infections.
Infrared saunas, which utilize an infrared bulb to create heat, are now
available in the form of a cabinet you sit in, a bodysuit you zip up, or lamps that
project localized heat to activate a specific area of the body. Three different
forms of light are emitted in the infrared spectrum—these are near infrared,
middle infrared, and far infrared. Far infrared, the type used for therapeutic
value, has the ability to penetrate 0.8–1.2 inches (2–3 cm) into tissue without
causing burns or negative side effects. While the mechanism is not fully under-
stood, studies have shown improved circulation, reduced pain, enhanced energy
levels, and improved insulin metabolism.10
very gentle compared with the typical pressure used in massage therapy.
Practitioners are trained to apply pressure to specific locations until they
become aware of the fascia releasing, thus allowing unimpeded flow of
cerebrospinal fluid. This can also lead to subtle changes in the bones of the
head. The sutures of the brain, long thought to solidify after early childhood,
still make very slight movements to adjust for pressure within the head while
maintaining strength to protect the delicate brain.
Restriction in the flow of cerebrospinal fluid can cause impaired function-
ing of motor neurons, sensory neurons, and the sympathetic and parasympa-
thetic nervous systems. Impaired flow has a dramatic impact on the glial cells,
which make up a majority of the brain mass and have important functions in
maintaining homeostasis in the brain. They form the protective myelin
sheaths around nerves, help hold nerves in place, detect imbalances in the
brain, attack invading microbes, oxygenate neurons, play an important role in
our ability to breathe properly, and keep order in the brain.
If you are experiencing stress to the nervous system, you might find it
helpful to seek out a practitioner trained in craniosacral work. This will
typically be a massage therapist, chiropractor, osteopath, or another practi-
tioner trained in administering physical medicine modalities. Treatment in
this modality could decrease Herxing symptoms and help with recovery.
Research has already documented its benefits to those who have suffered
concussion or who have persistent headaches, traumatic brain injury, or
debilitating back pain.
In Summary
Chronic illnesses such as Lyme disease mean that the body is a very uncom-
fortable place to be. And if the body is uncomfortable, it can be hard to see the
possibility of recovery. You can get stuck in pain cycles, physically, mentally,
and emotionally. Engaging in some form of self-care, whatever is physically
possible, can change your outlook dramatically by enhancing neurotransmit-
ters, improving the flexibility of your body by enhancing circulation, and
creating a deeper mind-body connection.
Physical medicine is about regrowing the body you desire for the future.
Start simple and keep showing up for yourself daily with some form of activity,
no matter how minimal it may seem. Engaging in self-care to strengthen,
lengthen, and relax your body is an act of intention designed to heal. Repeat-
ing the activity you choose with patience will signal your body to make
positive changes.
PAR T
3
WH E N LY M E
PERSISTS:
IT ’ S TI M E TO
DIG DEEP
CHAPTER 10
THE NEW
NORMAL:
LIVING WITH
CHRONIC
LYME DISEASE
ou finally have a diagnosis that explains your multitude of symptoms.
Y You have an answer. Tears flow, and with them comes relief. But relief
is followed by trepidation about what’s to come. What will the future
look like? You waited so long for the answer—and questions arise
about why it was so hard to find. Why didn’t other doctors address your symp-
toms and concerns? Why were you forced to go from one doctor and treatment to
another, looking for relief? These are not easy questions to answer, but it is help-
ful to acknowledge that, as I’ve mentioned before, there is a distinct pushback in
parts of the medical community regarding a diagnosis of chronic Lyme disease.
Now that Lyme disease and other tick-borne infections are part of your life,
you may experience Lyme disease culture shock. Chronic Lyme disease has its
own nuances of terminology, process of recovery, socioeconomic impact, and
unique presentations based on age and gender. In addition, a diagnosis of Lyme
disease brings its own set of emotions that rise up and lead to certain changes
within the individual and in family dynamics. Many variables affect the
duration of recovery, the treatment and circumstances it takes to recover, and
the ways in which a patient’s life will change for a period of time.
179
Providing encouragement for my patients is where I spend a lot of time
during office visits, but it is so necessary for patient recovery. My office is a
safe space where patients do not need to explain themselves or defend their
diagnosis. Knowing this, patients often start to cry. The stress can be over-
whelming after they have felt sick for so long and have dealt with confusion,
doubts, and a fear that they will never get their quality of life back, coupled
with the strain of maintaining an appearance of regular life. Patients’ worries
are often compounded by the stress on their caretakers, who are frequently
overlooked but may work themselves to the bone to help their loved ones. The
lives of caretakers can change dramatically, too, particularly if income levels
in the house drop because not only the patient but also the caretaker is unable
to work due to the needs of the patient.
So many variables make having chronic Lyme disease more difficult than it
needs to be, and we have discussed many of them throughout this book. One of
the most common conversations I have with patients concerns the reasons
their primary care doctors did not acknowledge their Lyme disease. Polarized
opinions of doctors regarding chronic Lyme disease confuse patients, who lose
touch with their intuition because for so long they have seen specialists,
emergency room doctors, and primary care providers who tell them nothing is
wrong except anxiety.
After a formal diagnosis of chronic Lyme disease, patients need time to
deprogram; though they’d experienced ongoing symptoms, they had con-
vinced themselves that everything was in their head, based on what others
told them. Now they have developed trauma, anxiety, and possibly even
psychosis because of the labels applied to them. It was just easier to accept
mental imbalance as their reality.
The task of helping patients overcome medical trauma can also make being
a Lyme-literate doctor difficult, as we must manage conflicting information in
the media about Lyme disease. We also tend to take the brunt of the emotions
from patients as they process feelings of confusion and betrayal. I spend a lot
of time addressing new therapies patients read about in blogs, consoling those
who have had confrontations with doctors, and coaching patients through
Herxheimer reactions made worse by stress. All of this causes patients to
second-guess their treatment plan, which leads to doctor-hopping as they
explore the wide variety of treatments with differing philosophies, price
points, and promises of cure.
Discussing the plight of those who suffer from chronic Lyme disease and
other tick-borne infections is a service to those who are not being heard. I
want to address here the trauma aligned with the label chronic Lyme disease
and emphasize the way it integrates with the trauma a person carried before
diagnosis. While not everyone who has Lyme disease has trauma, many do.
Just enduring the medical difficulties we’ve discussed, living with symptoms
and prolonged debilitation, and trying to find a treating doctor can be traumatic.
My contribution with this book is to acknowledge patients’ experiences and
open a dialogue to advance understanding of this complex disease.
I want to emphasize that I am not a licensed counselor or therapist. My
undergraduate degree is in psychology, and before attending medical school,
I worked for several years in social work with at-risk populations—including
those who were homeless, escaping violent homes, or suicidal—and I advocated
on behalf of those in crisis after a rape. I have spent several years in medical
practice, providing counsel and referral for patients going through personal
difficulties and have had many discussions regarding their personal safety and
intent to harm themselves. I have also worked in conjunction with counselors
in a team approach, providing a safe space for patients to talk about trauma
and discussing coping mechanisms they can integrate into their daily lives.
Working with those who have tick-borne diseases involves counseling patients
daily. However, it’s important to have licensed mental health professional on
board who can support patients throughout their treatment.
Trauma and
Tick-Borne Disease
Trauma is derived from a Greek word meaning “a wound,” and in psychologi-
cal terms, it means “witnessing or experiencing a horrifying or shocking event
and feeling intense fear or helplessness afterward.” The latest edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) features the
most expansive criteria for post-traumatic stress disorder (PTSD); until this
edition, a diagnosis of PTSD had been highly controversial, even though most
patients who seek counseling have past trauma as defined by the manual. We
have all had trauma at one time or another, and it does not have to be extreme
to qualify because a trauma is subjective. Severity and duration, however, can
determine the intervention required.
While the wounds created by trauma can be physical, the physical wounds
heal; mental-emotional wounds can remain for a lifetime if they are not
resolved. How well trauma is resolved depends on the support the person
receives after the event(s) and on the person’s resilience, which makes the path
highly individualized. Through the processes of dissociation (disconnecting
from thoughts, feelings, or memories), repression, and fragmentation, our
traumatic events can be stored in the shadows of the mind—these are part of
T H E N E W N O R M A L : L I V I N G W I T H C H R O N I C LY M E D I S E A S E 181
humans’ natural survival mechanisms. These
mechanisms represent an important process of
Thankfully, coping rather than a weakness or a failure. However,
due to neuro- when these coping mechanisms outlive their useful-
plasticity … ness (helping us survive) and become a source of
more suffering, the condition is diagnosed as PTSD.
we can rewire
Dissociation is related to fragmentation, in which
our responses thoughts and actions are split. When someone
and heal from witnesses something shocking, his mind tries to
trauma. minimize suffering and ensure survival by
repressing the event (excluding the thoughts from
the conscious mind), losing memories of the situation, and/or creating altered
versions of the story. A traumatized person may also feel numb or detached
from his body. As the trauma continues, the memories or parts of the psyche
can fragment, splitting off into pieces, because the reality being presented
does not make sense or is intolerable. These pieces are banished to the
unconscious mind but can reemerge later.
In some circumstances, detachment or dissociation can be a healthy
process, as this helps us maintain proper boundaries in our relationships and
in our interactions with the world. For instance, you could feel an emotional
punch to the gut after seeing a news story. You can either stay with those
feelings or detach from them. You can’t fix all the suffering in the world. In
this situation, you might dissociate from the news story and instead do your
best to create positive change around you.
Fragmentation is the breaking down of memories so they are not accessi-
ble. This is most common after prolonged childhood trauma, where a person
forms a new personality out of a necessity for survival. Fragmentation can
thus lead a person to be detached, numb, emotionally unstable, perfection
driven, codependent, anxious, outgoing, or gregarious. There also may be no
perceptible sign of a person’s wounds. The way people cope with trauma is
extremely diverse and is based on individual circumstances and particular
psychological makeup. Some may rise above the trauma into a lighter state of
being, while others sink deeper into darkness. Often, the same person will be
involved in an ongoing process of visiting the extremes of both worlds.
A child’s brain is like a sponge, and primitive survival mechanisms can
bury traumas deep in the brain if the child does not have the language or
context to process the event fully. Children deal with unloving acts, pain, and
shocking events by trying to make sense of them, often by creating a belief that
the event was their fault, feeling deep shame, or hiding their resentment of
others. Thankfully, due to neuroplasticity (our brains’ ability to change), we
can rewire our responses and heal from trauma. This is usually done with the
help of others in the medical, psychological, and/or spiritual field who can
help us access memories while ensuring that we remain stable.
I gather a trauma history for almost every new patient. Initially, the
patient may not feel comfortable sharing these experiences. When I ask
patients if they have experienced any traumatic moments, many will first say
no but will then launch into deeply troubling experiences. They may claim
that these experiences are resolved or that they did not consider the situations
traumatic when compared with things that have happened to others. They tell
their stories with little to no emotion, or even make light of them—including
stories of abuse, near-death situations, sexual trauma, medical trauma,
neglect, military trauma, extreme violence, loss of loved ones, homelessness,
drug addiction, incest, and more.
Many patients see little or no correlation between their current situation
and past trauma. Discussing the role of trauma in chronic Lyme disease is tricky
because of the risk that the patient will lose trust in me if they feel I am saying
the disease is largely a mental-emotional problem. Also, it is important to let the
patient take back his power in the situation; it is my role to provide an opening
for discussion but not to force or coax information about past trauma from them.
P O S T-T R AU M AT I C S T R E S S D I S O R D E R
A N D C H R O N I C LY M E D I S E A S E
PTSD commonly affects the Lyme disease treatment process, as old wounds
are reopened and are compounded by increased inflammation in the brain due
to the microbial infection. It can be very difficult for patients to wade through
painful emotions while recovering from an infection. Many report a fear of
being watched, recurrent nightmares, fear of the outside environment, and, of
course, fear of bugs. In several cases, patients have developed agoraphobia
after being isolated for a long period of time and spending so much time at
home. They can have unpredictable physical spells such as seizures, problems
with speech, debilitating hypersensitivity to light or sounds, or fainting spells.
Patients also experience flashbacks, emotional overreactions to small
stressors, bursts of anger, violence, obsessive thoughts, self-medicating,
thoughts of harm, and self-abuse. These intense reactions are then followed by
sorrow, shame, and embarrassment. They are shocked by their own behavior
or feelings because these reactions are contrary to their normal behavior; they
feel as if someone else took over. Extreme reactions are not necessarily trauma
driven, but reactions from neuroinflammation can create future traumas that
require care if they are not addressed appropriately at the time of the incident.
This is especially difficult with younger children, who can’t fully understand
why they are feeling or acting this way. PTSD affects relationships within
families, with friends and coworkers, and especially with partners.
There are many similarities between those with PTSD and those with
chronic Lyme disease. Both tend to experience loss of friendships, social
networks, and jobs as well as higher divorce rates. They often have reduced
social support because of the ongoing nature of the illness; friends and
acquaintances fall away because of their own difficulties in holding space with
someone who is chronically ill. It’s hard for relationships to hold steady when
one person changes dramatically. The person who is ill may be unable to
participate in the activities that gave the relationship its connection.
Being chronically ill and trapped in a sick body causes old fears to reemerge
in many patients. Denial of the illness by a medical doctor and/or Herxheimer
reactions lead the patient to feel victimized or abused all over again. Patients
with chronic Lyme disease and other tick-borne diseases who have unresolved
trauma are my most debilitated population, taking years to recover, with more
intense neurological presentations that limit their physical, mental, and
emotional function. They tend to be more sensitive to medications, have
frequent relapses, are unable to emotionally tolerate Herxheimer reactions, and
often abandon treatment because of a heightened fight-or-flight response.
Those suffering from both PTSD and chronic Lyme disease may feel that
they can’t trust their own bodies. The risk of being seen in public in a vulnera-
ble state limits these patients’ outings, further isolating them. This can lead to
profound loneliness and a sense of being shut in by their failing body. People
who loved the outdoors may become petrified to go outside for any length of
time, for fear of getting a tick bite. Even a short trip to the mailbox can cause
panic. People who were outdoor enthusiasts no longer do what they love out of
fear of being bitten again.
SUICIDE RISK
One of my main motivations for writing this book is the harsh reality that
chronic Lyme disease patients struggling with the illness may begin to think of
suicide. In an article titled “Suicide and Lyme and Associated Diseases,” Robert
Bransfield, M.D., reports a high level of suicidal ideation in Lyme disease
patients. He correlates suicide attempts with neurocognitive changes in the
brain, due to increased neuroinflammation, that cause thoughts of self-harm. In
addition, negative attitudes toward chronic Lyme disease sufferers cause patients
to feel alienated.1 The fact is, most people who die from Lyme disease and
associated coinfections die by their own hand. It’s a heavy burden to carry the
disease and defend it at the same time. But this does not have to be the reality;
much suffering could be eliminated if patients, families, the medical community,
and government approached patients with greater compassion and inclusivity.
Suicidal ideation is nondiscriminatory—it affects those of all ages and
genders. I have seen children diagnosed with Lyme disease and pediatric
autoimmune neuropsychiatric disorders associated with streptococcal
infections (PANDAS) who show cutting behaviors, have thoughts of suicide, or
exhibit other forms of self-harm, necessitating psychiatric care. Children and
adults with no apparent history before contracting tick-borne disease become
suicide risks. While a great deal of detail about PANDAS is beyond the scope of
this book, it’s important to screen children who may be affected for strepto-
coccal antibodies, along with testing for tick-borne disease, especially if a
patient exhibits psychiatric symptoms after the onset of fever, sore throat,
confirmed strep infection, or flulike symptoms.
The stigma surrounding chronic Lyme disease creates an atmosphere in
which patients feel the need to hide symptoms, which enhances stress and
shame. Among the lowest emotional states, shame involves humiliation and
isolation and can bring one eventually to thoughts of self-harm just to end the
suffering. This is mostly due to prolonged pain, mental and emotional imbal-
ance, and isolation; but these symptoms could largely be avoided if we ended
the social rejection of those who have chronic Lyme disease and funded
education for the general public to foster greater compassion and awareness.
Resisting Counseling
When It’s Needed Most
At the core of trauma as it interacts with chronic Lyme is fear and the hyper-
vigilance that comes from feeling that we live in an unsafe world. If the body
feels unsafe, it will respond with an impulse to escape or to freeze, whether the
threat is real or imagined. For many, the train tracks for these behaviors were
laid long before Lyme disease came along, and the process of treatment and
recovery acted as an emotional trigger that brought those feelings to the
surface. If this happens, it is important to have proper psychological and social
support in place. Leaping into trauma work at a vulnerable time is not always
something a patient is ready to do, and that is okay. Everything has its unique
timing. My job as a doctor is to have the dialogue, open the door to the possibil-
ities, and then help the patient find the most appropriate treatment option.
While we may associate the ability to keep moving on with strength, all we
do when we do not treat trauma is compartmentalize the pain to be experi-
enced in the future. This affects our daily life, certainly, but unresolved PTSD
can also increase anxiety, depression, and mood imbalance in offspring even
one or two generations later, referred to as transgenerational trauma (I will
discuss this more later in the chapter). 2
Many patients resist the idea of seeing a counselor until they are brought
to a point of surrender; they must nearly break down before they can see the
connections between their current health and the old wounds that haunt
them. Avoidance of counseling can also be due to a person’s general opinions
about its efficacy; her gender, age, or fear of being vulnerable; associated costs;
and concern about the time it will take. The biggest concern a patient may
have is that she will see a therapist who does not believe she has Lyme disease.
This, again, comes from the medical trauma of being humiliated or disbelieved
by other practitioners.
I let people know it’s not important that a counselor understand Lyme
disease, although that is helpful. What is critical is that the counselor is
trained in trauma work and family counseling and that he or she is compas-
sionate. Counseling offers an opportunity to process emotions and gain skills
needed to cope with a difficult life situation.
Every person’s timing is different with regard to their call to do trauma
work. A health crisis can be a turning point that presents an amazing opportu-
nity to change. I have seen profound changes in people who have rigid defense
mechanisms, and who refuse to see their illness as anything but a purely
physical problem. Eventually, though, they soften and begin to open them-
selves to receiving help. The ability to ask for help, receive help, and be okay
with being vulnerable are some of the major emotional blocks that Lyme
disease patients experience. When they do allow themselves to receive help,
they heal much more efficiently. This does not mean recovery is easy, but they
experience breakthroughs so strong that, even if the body is not fully recov-
ered, they can improve self-care and feel greater joy and peace. It’s amazing to
watch a person find her grace.
Your Trauma Is Not

Yours Alone
Trauma has many layers and different origins: There is individual trauma,
transgenerational trauma, and collective trauma. These are defined separately
but can overlap throughout life. The way we are affected by one trauma affects
how we handle others. Individual trauma is what we experience in this
lifetime based on what happens to us directly. Living in the world means we
are going to see, hear, and feel difficult things. These experiences shape our
reality—our view of our surroundings and the people we meet. However, this
view was set in motion by our families and our culture.
Grassroots Efforts to Create
Community Support
IN MY AREA OF SOUTHERN NEW HAMPSHIRE, I have watched grassroots
support groups create networks that help Lyme disease patients find others who
understand their journey and exchange names of doctors who will treat them.
These networks are like local chronic Lyme disease phone trees. Typically, if
someone is even minimally vocal about having recovered from Lyme disease, they
get flooded with emails, phone calls, and inquiries. They become an information,
referral, and support network as well as a crisis line. Many of my patients formed
relationships in my waiting room and while receiving intravenous therapy in my IV
suite. They banded together to create a support group so they could balance the
workload of all the community support they were already doing from their own
homes. They rotate meetings at different homes a few times each month.
T R A N S G E N E R AT I O N A L T R AU M A
We have focused on individual trauma throughout much of this chapter, but
most of us come from families with many generations of trauma. Transgenera-
tional traumas are those that have been passed down from generation to
generation. These might include, for example, your family migrating to a
different continent and barely scraping by. Such an experience can dramati-
cally affect a whole family and change the way individuals will parent. They
may pass their fear of scarcity down to future generations. This fear can move
through several generations, until no one really knows why they have certain
tendencies; they just report that being depressed, angry, or anxious runs in the
family. Experience of scarcity can manifest as worry over not having enough,
fear of failure, overindulgence, hoarding, or fear of spending money, which
limits enjoyment. This is just one example of a core transgenerational trauma
centered around survival and primitive needs.
Family Constellation Work, developed by Bert Hellinger in the 1990s, is a
method of healing unhealthy family patterns. This work is done in a group
therapy setting; the group does not need to be related or even know one
another. As the therapy session opens, the group will start to gain insight into
the origins of the conflict that affects a seeker (a person looking for help) from
the perspective of their ancestors, as data start to emerge through the group.
The group is accessing the unconscious information field of the seeker’s family
in order to identify the origins of unhealthy patterns that have moved through
generations. Groups are facilitated by trained counselors who help maintain
emotional safety throughout the process. For more information on healing
transgenerational trauma, consult Mark Wolynn’s It Didn’t Start with You:
How Inherited Family Trauma Shapes Who We Are and How to End the Cycle.
Recently, a patient of mine attended a group session in Family Constella-
tion Work. She reported that those who have chronic Lyme disease also have
conflict rooted in being without a clan. I had to sit with that for a while
because at first the connection was difficult to make. Being without a clan
relates to loss of family identity, feelings of aloneness, lack of support and
group protection, and feelings of being essentially cut off. Humans used to be
heavily associated with their group identity—with their tribe, clan, and the
land. I find it interesting that the Borrelia spirochete moves from mammal to
tick back to mammal. It is constantly being moved from one extreme environ-
ment to the next. It is drawn in by the tick, harbored, then pushed back out
again to start anew. I feel there is a connection between the energy of the
microbe and our own inner conflict of being without the support we may need
within our family unit. I’ll talk about the relationship of microbes and inner
conflict more in the final chapter of the book.
Again, it’s important to remember, when speaking from a transgenera-
tional perspective, that your family may have a loving and supportive struc-
ture, but if we were to look several generations back, there may be unconscious
inner conflict that affects your health today.
Researchers are using animal models such as mice to watch the changes in
successive generations, observing both negative and positive outcomes from
stressors in their ancestors. They are also studying the impact of trauma on
gametes (sperm/egg) and genetic alterations that happen in utero. The point of
this research is to understand observable biological changes rather than
relying solely on a psychological perspective. We also need to know if succes-
sive generations can reverse these pathways and how they heal them over
time. Can traumas in fact help later generations develop adaptability to stress?
Most research in trauma and epigenetics is done by creating trauma in
mice and then watching successive generations respond to the trauma.
Researchers track genetic markers associated with PTSD and mental illness,
such as the FKBP5 gene, and they watch modification through methylation.
Replicating this type of study in humans would not be ethical, of course, but
longitudinal studies have followed those who have survived horrific trauma,
such as the Holocaust, and looked at the genetic changes in their offspring.
Those who survived the Holocaust had an upregulation of genes triggered by
PTSD as well as those that affect stress hormone release and mood disorders,
as would be expected. Then researchers found that this same gene was altered
in the survivors’ offspring but in a dramatically different way. 3 Researchers
are continuing to work in this area to understand how the genetic makeup of
offspring are affected by changes to the parents’ genes.
CO L L E C T I V E T R AU M A
Collective trauma is the wave of energy that moves through a large group of
people and engenders a collective fear based on a trial experienced by the
group. This creates a change in culture that can take generations to heal
because of the large scale of the event and the depth of the fear or pain. War,
genocide, and environmental calamity are all examples of events that can lead
to collective trauma. In the information age, we have greater awareness than
ever before of the suffering in the world, and many of us are affected by the
ills of other cultures that we would not have known about in previous decades
or centuries.
When embarking on trauma work, you may have emotions rise up in your
awareness that are not relevant to your current life but which may have been
part of a pattern held in your cellular structure over generations. Fear of
scarcity, a feeling of not having a homeland, shame, shock, grief, addictions,
attachments, and a feeling of not living up to expectations are just a few of the
emotions we may experience. We can heal with conscious effort, but we need
to understand that it’s normal to have these feelings emerge. It’s also helpful
to work with a counselor or other practitioner who can guide you through the
healing process as gracefully as possible.
Your Brain Is Plastic

Fortunately, we humans are highly adaptable, not only as a species but on an
individual level as well. Neuroplasticity is the ability of our nerve synapses to
regrow based on learned behavior. For many years, scientists believed that the
brain could not be changed, that it operates in a fixed way. The acceptance of
neuroplasticity—the ability of the nervous system to reorganize itself in
response to injury, illness, sensory data, developmental changes, or damage—
represents a big shift in this long-held belief. Nerves form new synapses and
branches to relay sensory information; these branches are also pruned back by
microglia to maintain efficiency when they are no longer of use because
positive changes have occurred or due to injury.
Your brain’s plasticity is the reason that it is important, if you want to
regain or enhance function, to continually expose your body and/or mind to
the desired experience; this sends a message to the system that these neuronal
branches are necessary. For example, to regain
strength or endurance, don’t wait until you feel strong
To regain enough to do a task. Start the process, no matter how
strength or minimal, to create the body strength you desire.
endurance, The same is true for developing better memory.
You need to engage in the activity to regrow new
don’t wait until
neurons. This can be retraining your brain with
you feel strong programs such as those available through Lumosity
enough to do a (www.lumosity.com), using the opposing hand for
task. Start the basic tasks (if you are right dominant, then use your
left hand to brush your teeth), learning new skills,
process, no mat-
reading, and writing. Set aside judgment of the
ter how minimal, outcome; your result is not about being graded but
to create the about the doing.
body strength In his book The Biology of Belief, Bruce Lipton,
Ph.D., discusses in depth the amazing ability of the
you desire.
body to heal and rewire itself based on new stimuli.
Many other practitioners and scientists have also understood this, as have
traditional healers throughout the ages. As we heal our wounds, we have limitless
potential for positive changes and for growth of new neurons better aligned
with healthy thinking, feeling, and mind-body connection. To learn more about
neuroplasticity, read The Brain That Changes Itself, by Norman Doidge, M.D.
Epigenetics:
Finding Our On-Off Switch
The initial theory of genetics, now disregarded, is referred to as preformation.
Under this theory, we are born with everything we will need carried in the
embryo, and these traits gradually reveal themselves over a lifetime, with
no variability.
Epigenesis is now the more accepted viewpoint. Epigenetics, a term first
introduced in 1942 by embryologist and developmental biologist Conrad
Waddington, is the ability of our environment to influence our bodies as we
move through our lives.4 Our genetic code is the blueprint for cellular growth,
development, and regeneration as well as eventual degeneration. Our DNA
sequence can’t be altered, but it can adapt during our lifetime.
This “study above our genes”—epi means “on” or “above”—involves
research into the proteins responsible for turning genes on or off based on our
diet, sleep quality, lifestyle choices, stressors, traumas, and beliefs. These are
all areas over which we have control. DNA is like a tightly wound circuit board
that can be activated or deactivated based on messages received from the
external environment. Certain mechanisms—two of the most researched are
methyl groups (an alkyl derived from methane) and histones (proteins found
in chromatin)—can turn genes on and off; they can silence a gene, subtly
enhance it, or activate it, depending on the needs of the body as well as
response to stressors.
Here, we will quickly revisit microglial cells (immune cells of the brain)
because a lot of research is working to better understand their role in brain
inflammation, studying pro-inflammatory pathways involved in Alzheimer’s
disease, drug addiction, strokes, multiple sclerosis, chronic Lyme disease, and
several other conditions. It was once thought that microglial cells were largely
inactive unless there was acute injury; however, research is showing that they
are in constant movement, using methods of epigenetics such as methylation
to implement action. The better we understand these mechanisms, the more
effective our solutions to reduce the brain inflammation that causes debilita-
tion.5 Currently, little research is focusing on epigenetics and Lyme disease.
Hopefully, this will change. The important takeaway here is that our immune
response to Lyme disease spirochetes can be modified by our behaviors, diet,
and management of stress. We have more control than we think.
Conversion Disorders and

Psychosomatic Medicine
While we have great potential to adapt to our environment and heal ourselves
from many illnesses, when our mind and body are out of balance, our ability to
fight off disease and function optimally is curtailed. Many patients who come
to my clinic have previously been given a diagnosis of psychosomatic manifes-
tation of illness or conversion disorder. Psychosomatic illness is defined as a
disease or disorder caused by, or made worse by, mental factors, including
stress. A conversion disorder is a condition caused by mental factors but which
takes on a neurological component such as fits of shaking, seizure-like activity,
transitory blindness, and/or loss of sensation in the body. Symptoms listed
above commonly occur in cases of tick-borne disease, as spirochetes can cause
deterioration of nerves, depending on the host’s immune system and stress.
I have treated multitudes of patients who have had a diagnosis of conver-
sion disorder, which has been used to dismiss their symptoms and cause shame.
I have seen patients mentally and emotionally harmed when doctors tell them
that they need to accept that they do not have Lyme disease and should instead
seek a mental health practitioner or start taking a mood-stabilizing medication.
This approach causes patients to feel humiliation and alienation, and it fosters
negative thoughts. This experience causes further shame, aversion to seeking
medical care, and increased suicidal ideation.
We need to understand more fully how the psyche holds on to negative
beliefs, thoughts, and fears and how imprints from old traumas change the
health of the physical body, making it more hospitable to illness. These are
not new concepts, but they have gone in and out of favor over the past century
as attitudes toward mental illness changed. The advent of psychiatric
medications led to drugs becoming the primary answer to mental or emo-
tional problems, when there is typically an underlying conflict that has not
been addressed.
Psychosomatic medicine is really expanding in the medical field, blending
several medical specialties, including psychology, psychophysiology, sociology,
and psychoneuroimmunology (a focus on thoughts, beliefs, and emotions on
the neurological and immunological systems).
Placebo and Nocebo Effects

When I was in medical school, I spent a lot of time in the library, as most
medical students do. My favorite book was about five inches (13 cm) thick and
was called Spontaneous Remissions. This book was filled with seemingly
miraculous recoveries. I was intrigued by the countless case studies, written
up by physicians and clinicians all over the world, of individuals who defied all
odds by shrinking softball-size tumors with the belief they were being cured
by trial medications, when in fact they were in the placebo group. (A placebo is
a medication that has no therapeutic benefit other than the strong belief of the
patient that it’s beneficial.)
In the medical community, treatment response categorized as the placebo
effect is often used to downplay the patient experience or the benefit of a
medication. I most frequently hear about the placebo effect with regard to
homeopathic medications, which are diluted substances that create changes in
the system on the cellular level—or even the quantum level. While this
certainly may seem to fit the criteria of a placebo, I have seen distinct and
powerful healing outcomes with the use of homeopathic treatments. I
personally think we just do not have technology that would allow us to fully
witness how these medications work.
An Epidemic of
Psychosomatic Disorders?
IF LYME DISEASE IS NOT THE PROBLEM, as many practitioners believe, we need
to investigate the apparent epidemic of psychosomatic illness. Many patients are
referred to a counselor, placed on medications for depression/anxiety, and told
that all their problems are rooted in a psychiatric issue. Patients who choose not
to accept this as their answer are still left with a worry in the back of their minds
that they really are mentally ill, which only creates more inner turmoil.
Once a diagnosis of conversion disorder or psychosomatic illness is placed in
a patient’s chart, it follows him as he is referred to specialists such as neurolo-
gists, cardiologists, and so on. Accessibility to electronic records within hospital
systems makes it even harder to escape the labels. Such a diagnosis has the
power to change the perception of the next practitioner reviewing the case.
Patients have reported, on many occasions, that doctors have either refused to
see them after reviewing their charts, saying they couldn’t help, or that it would
be a waste of time for the patient to come in if the purpose is to discuss Lyme
disease. While it may sound as though I am throwing the conventional medical
community under the bus, I have great respect for the many medical doctors
who are compassionate and open minded about chronic Lyme disease; however,
the problems reported by hundreds of patients over the years who have visited
multiple clinics and heard the same skeptical speech must be acknowledged
before we can begin to change attitudes to better serve patients.
We also see an opposite of the placebo effect, called the nocebo effect.
Nocebo actually means “I shall harm.” This is a psychological manifestation
rooted in negative experiences with medical intervention or medications, or in
a general belief that something bad will happen. The nocebo effect has an
important role in chronic Lyme disease treatment. After being diagnosed with
Lyme disease, the first thing most patients do is search the Internet or talk to
others about Lyme disease. As they hear or read other people’s difficult stories,
they form a belief that their own experience will be as challenging.
Our culture is highly ambivalent about medication: We are afraid to be
without it, and at the same time we fear taking it. The television commercials
drug companies produce to convince us we need their medications end in a
rapid-fire list of horrifying side effects. Picking up medication at the pharmacy
is likewise difficult, as we walk away with lengthy printouts detailing every
possible calamity that could befall us if we take the drug.
Thus, the nocebo effect can be triggered by simply
picking up the medication at the pharmacy or by Inter-
When doctors net research. Many patients have an aversion to taking
support the pills; they resent being tied to a medication regimen or
patient’s choice, are afraid because a medication caused an adverse
event in the past. They project that negative feeling
even if they do
onto the new medication and expect it, too, to fail.
not fully agree Anxiety and confusion in the medical community
with the diagno- over chronic Lyme disease only amplifies these
sis, the patient worries. Another significant cause of the nocebo
effect is practitioners who disagree about whether
experiences a
chronic Lyme disease is real. When a patient has a
better outcome. negative interaction with a doctor such as his
primary care provider about his Lyme treatment
protocol, the doctor’s attitude affects the patient’s response to medication. It
seeds doubts regarding the diagnosis and may eventually lead the patient to
abandon treatment. When doctors support the patient’s choice, even if they do
not fully agree with the diagnosis, the patient experiences a better outcome.
The placebo and nocebo effects are where the power of intention meets
science. Instead of thinking of these effects as an annoying extraneous factor in
research studies or treatment, let’s look more deeply at the powerful medicine at
work. The medicine is the power within each of us to manifest our own healing
by making a choice, both conscious and unconscious, to heal. The more we heal
our trauma and release negative thoughts, the more deeply we can access the
healing aspect of self. This is a superpower we humans have always had, but we
forgot we had it. By using mind-over-matter techniques, people may be able to
resolve wounds by letting go of old thoughts, beliefs, and attitudes.
For more information, check out the following books by Joe Dispenza,
D.C.: Breaking the Habit of Being Yourself: How to Lose Your Mind and Create a
New One, Becoming Supernatural: How Common People Are Doing the Uncom-
mon, and You Are the Placebo: Making Your Mind Matter.
Understanding How
We Are Wired
We can make the most of our abilities to make good decisions for ourselves
and channel healing when we understand our responses, both conscious and
unconscious, to our inner and outer environments. This overview explains the
human nervous system as it relates to emotion, stress, and behavior, all of
which affect both the progression of chronic Lyme disease and its treatment.
As I discussed briefly in chapter 2, our nervous system is made up of the
central nervous system and the peripheral nervous system. The central
nervous system acts as the central processing unit of the body and is made up
of the brain and the spinal cord. Moving out toward the periphery from the
spinal column is the peripheral nervous system, which is divided into the
somatic nervous system and the autonomic nervous system, further divided
into the sympathetic nervous system, the parasympathetic nervous system,
and the enteric nervous system. These all facilitate informational exchange,
taking information in from the outside world, sending it to the central
processing unit (brain), and then delivering a response. They are not separate
but interdependent, providing us with the ability to experience a full life.
T H E S Y M PAT H E T I C N E RVO U S S YS T E M
The sympathetic nervous system is about fight or flight. This mechanism
makes us more vigilant and gives us the momentum to get ourselves out of
danger. It helps the body and mind stay sharp in the moment so we can draw
on bursts of energy to physically get through a dangerous situation. Our
muscles receive more blood, which is shunted away from the gastrointestinal
system, blood pressure rises, and our eyes open wider to improve visual acuity.
A flood of the stress hormone cortisol can hyperstimulate the limbic system,
an area of the brain related to fear response. If this response is triggered
repeatedly, our brains may be rewired toward an outlook that life is not safe.
The limbic system lies deep in the cerebrum, close to the center of the
brain; in this book, we are primarily interested in the amygdala and the
hypothalamus. These areas of the brain are both involved in emotional
response. The hypothalamus regulates the autonomic nervous system, which
governs the stress response as well as many other functions in the body. The
amygdala is specifically related to feelings of anger and fear. The amygdala is
hyperstimulated in patients with a past history of trauma; they often have a
fear response, even in nonthreatening situations. Trauma can be stored in
multiple areas of the brain, which records sensations such as the taste, touch,
smell, and sound associated with the events. The sense of smell has its own
pathway related to memories, which is why odors can trigger memories and
affect mood. The strong relationship to sensory experience is why people can
have vivid memory recall or flashbacks related in which the sensory data are
so real that a person feels as though she is in the situation all over again.
Without proper support, this can be difficult to work through in a healthy way.
The need to repress bad memories for self-protection often attracts people to
numbing agents such as drugs or to avoidant behaviors that can distract them.
Lyme Rage
IN AN ARTICLE TITLED “Aggressiveness, Violence, Homicidality, Homicide,
and Lyme Disease,” Dr. Robert Bransfield addresses the increase in aggres-
sive behaviors in those with tick-borne infections. I referenced another of
Dr. Bransfield’s articles, on Lyme disease and suicide risk, earlier in the chapter.
In “Aggressiveness,” he opens a dialogue about violent tendencies in those
with neurological infections, specifically tick-borne disease. This is a topic of
critical importance, as we face a rising epidemic in the United States, where
many people with violent histories or mental illness have access to high-
caliber weapons.
Thankfully, a majority of chronic Lyme patients have a level of self-control
over violent actions; instead, they may turn aggression inward on themselves.
None of my patients has committed criminal acts that warrant legal action or
exhibited seriously violent behavior. However, my staff members and I have
been the targets of unwarranted outbursts and physically threatening behaviors
such as throwing items. These reactions are extreme, as the situations (such as
having to wait for a task to be completed) would cause the average person only
minor annoyance. Many chronic Lyme patients report increased aggravation,
with feelings of rage toward family members, friends, coworkers, and the world.
Some have reported violence in marriages, and patients have commented on
thoughts of doing harm to others.
In a review of 1,000 charts, Dr. Bransfield found that a majority of the
individuals studied did not manifest homicidal or extreme violent behavior until
after they were confirmed with Lyme disease and coinfections. In my practice,
I see aggression more frequently with the coinfection than with
confirmed Lyme disease. Among my patients, outbursts and harmful behaviors
are reported more by parents of young Lyme disease patients, who hit siblings,
throw items, threaten extreme violence, scream, and/or attack their parents.
These behaviors are usually shocking to parents, as they have not witnessed
these behaviors in their children before.
To explain the aggression, Dr. Bransfield points to hyperstimulation of
aspects of the limbic system, such as the amygdala, due to brain inflammation,
as well as inadequate serotonin levels. In addition, the areas of the brain that
create empathy and a sense of community show reduced function, and this can
override judgments that would inhibit violence. Other neurological factors are
involved as well, but they are too complex to cover here.
The implications raised by aggressive tendencies in those with chronic Lyme
disease and other tick-borne infections are troubling, as we see more cases of
Lyme disease as the incidence of mass shootings rises. The good news is that a
majority of patients, though they may feel more aggravated, would never
participate in this type of violence. But the more we research this phenomenon,
the better we will be at taking a preventive approach instead of waiting until
after disaster has happened to look for a cause. 6
T H E PA R A S Y M PAT H E T I C N E RVO U S S YS T E M
The parasympathetic nervous system is associated with the impulse to “rest
and digest.” When we feel safe, our mind and heart are at peace and send
messages to the rest of the body that it’s safe. When we feel safe, our digestive
system works like clockwork, blood flow is balanced throughout the body, heart
rate is steady, we feel more joy and less pain, and we have improved immunity
and balanced hormone function. In an ideal parasympathetic nervous system,
the body is energy efficient and a person feels comfortable in his skin.
T H E E N T E R I C N E RVO U S S YS T E M
The enteric nervous system is located in the lining of the gut. Sometimes
called the second brain, this system has more than five hundred million
neurons. It interacts with the other branches of the nervous system but can
also function autonomously. The gastrointestinal tract interfaces with the
outside world, as substances come in, and it communicates with the immune
system, the microbiome, and the internal world of the central nervous system.
It’s also tied to our emotional state, intuitive decision making, motivation, and
higher cognitive functioning.7 There are several pathways between the
gastrointestinal tract and the brain, including pathways that connect the
sympathetic nervous system, adrenal glands, and immune system. Pathways
also connect the amygdala, hypothalamus, and enteric nervous system
referred to as the Gut-Brain Axis, which are both involved in our emotional
responses, as discussed above. The three systems of the autonomic nervous
system strive to work in harmony, in service to the body.
T H E VAG U S N E RV E
The vagus nerve, or the “wandering” nerve, is the tenth cranial nerve and one
of the longest in the body. The vagus nerve communicates between the brain,
heart, lungs, and the visceral organs to maintain calm, and it serves many
functions, including assisting in swallowing and speech. It gives us the ability
to sense taste at the back of the tongue and also acts as the sensor modifying
behavior of the heart, lungs, and gastrointestinal tract. It lowers heart rate
and blood pressure, decreases inflammation, and helps maintain healthy, deep,
rhythmic breathing.
This nerve is all about feeling at peace, but it also innervates the sexual
organs. Many patients complain of a lack of libido during illness, which is not
only about hormones but also about the fact that they are not able to relax into
their bodies due to stress and discomfort. With elevated levels of stress, anxiety,
depression, and fear, the nervous system suppresses full sensation of pleasure.
However, the vagus nerve also works in a way that is more akin to that of the
sympathetic nervous system. This function is related to the polyvagal theory.
Neuroception and
the Polyvagal Theory
Stephen Porges, Ph.D., explains the human stress response with the concept
of neuroception and the polyvagal theory.8 According to Dr. Porges, we are
wired to survive but also need the ability to interact with one another so we
can maintain healthy social groups, create loving relationships, sense when a
situation is safe, and experience joy. Situations that feel unsafe are either
obviously dangerous, requiring our bodies to mobilize rapidly, or are experi-
enced internally like danger even when the outer experience appears safe. Dr.
Porges calls this process of perception and evaluation neuroception. I would
relate it to intuition, when our intuition is working in healthy state.
Dr. Porges uses as an example a child who responds to his mother with
calm and openness so he can receive love. Yet, if a stranger initiated the same
gesture that a mother does, the child would see it as dangerous and react
emotionally with rejection. This sort of reaction happens in adults as well. Our
nervous system reads situations as safe or unsafe, and we respond physically
when we discern that a situation may not be safe, even if it is.
Neuroception can become problematic if we have underlying beliefs,
emotional wounds, and negative thoughts created out of a trauma; that
experience runs in the background, influencing our behavior in an uncon-
scious way. The unconscious response can feel as if your mind is a horse
running out of control, with your conscious mind trying calm down. The
response can be hard to stop once it starts and comes in the form of increased
heart rate, sweating, shaking, irrational emotional responses, dizziness,
stimulation of the adrenal glands, and possible fainting.
This neuroceptive reaction can easily be out of sync with the actual
situation if the person holds unconscious beliefs that others or the world are
not safe. Clinically, I see the deepest wounds in those who experienced abuse
from a parent, where one (or more) of the most important relationships in a
person’s life did not represent safety. When a child grows up feeling a continu-
ous need to be on guard, the ramifications last over the course of a lifetime and
leave few reserves to help the body heal from an infection such as chronic
Lyme disease. Many of us may not have had an ideal childhood, but if most of
our needs were met, we learned to cope. If, on the other hand, our bodies
registered other people as unsafe, that reaction becomes hardwired into the
nervous system in an unconscious way.
A person whose neuroceptive reaction is out of sync might label himself as
having an anxiety disorder, depression, rage issues, or being fearful, and may
admit that he can’t help the reaction. Such an overreaction can also be related
to scenarios such as being required to give a speech and feeling the physical
sensations of stage fright. The neuroendocrine system is a powerful tool that
gives us the ability to discern and react in a quick fashion, but it can be
draining if it is triggered repeatedly.
Overly sensitive reactions also cause the quality of our social interactions to
suffer. The neuroceptive system can work against us when we react from a
place of emotional injury, in which unhealthy programs were built to defend us
and help us survive. Initially, these served a purpose, but they later become a
hindrance to healing. Because the danger response associated with neurocep-
tion can result from an outside perceived threat or an internal one, the inner
sensation of pain, illness, and fevers can bring out intensely fearful reactions.
The polyvagal theory identifies two branches of the vagus, each with a
different function, and addresses the relationship between experiences and
the reactions of the vagus’s parasympathetic system. According to the
theory, there are three types of responses: mobilization, socialization, and
immobilization.
Mobilization is triggered primarily by the sympathetic nervous system.
This is the fight-or-flight impulse to escape real or perceived danger. Our
senses become more acute, adrenaline pumps, energy is shunted to the body’s
muscles, the muscles of the face reflect fear, and our voice shows our stress.
This is what happens when we are in protective mode, summoning our ability
to defend ourselves while maintaining sharpened senses.
Socialization, or the social engagement system, involves the rest-and-
digest impulse and is the primary function of the parasympathetic nervous
system. Its function is to calm the heart, regulate digestion, inhibit the
adrenals from expressing stress hormones, and show welcoming facial
expressions. When we are in this mode, our voice is calm, and we create
healthy social interactions. The social engagement system is regulated by the
parasympathetic ventral vagal complex.
The third response, immobilization, is mediated by the vagal nerve as part
of the parasympathetic dorsal vagal complex. This is a primitive response. The
reaction involves playing dead physically, mentally, or emotionally; it can
literally create a freeze response, leading to reduced heart rate, unresponsive
facial expression, passing out, and a reduced ability to hear clearly or commu-
nicate. Emotions are flat; we shut down. We behave like a deer in the head-
lights or a small animal that ceases all movement instead of running away.
These three responses are all biological solutions created by the body to
survive based on information from past experiences. Why is it so important that
the chronic Lyme disease community understand these responses? If wiring
makes your nervous system overrespond or underrespond to a stressor, your
ability to move through the treatment process will be impaired. An out-of-
proportion response to stress may be one reason that some people recover
easily from tick-borne disease while others have a long and difficult road.
Many factors, known and unknown, contribute to this variability in
recovery, and when we look into unconscious biological wiring, our goal is to
learn to rewire ourselves for optimal health. Instead of seeing the body as a
betrayer holding on to illness, we can perceive it as a benevolent system with a
strong sense of protection. With mindfulness techniques and counseling, we
can learn to rewire these responses.
Since Dr. Porges brought his theory forward in the early 1990s, it has been
tested in many ways to study its implications for mental health, physical
illness, and other facets of human health. All three states—mobilization,
socialization, and immobilization—have a purpose, but they need to be in
balance to create resilience in the face of stressors. The freeze response, or
immobilization, happens when the other two systems are not able to provide
signals strong enough to override the lower neurological responses.
How can we strengthen our resilience and enhance a healthy neurological
response? An article published in Frontiers in Human Neuroscience titled
“Yoga Therapy and Polyvagal Theory: The Convergence of Traditional
Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience”
detailed a method of healing that views the body from top-down and bottom-up
regulatory processes. Top-down processes are related to meditation and
mindfulness practices that rewire our attention and intention. As we rewire
our minds for calm, we can improve our immune system, downregulate our
fight-or-flight response, and decrease inflammation. Bottom-up processes use
body movement (e.g, yoga or Qigong) and biofield therapies (e.g., Reiki). These
practices can improve the function of the digestive system, musculoskeletal
system, cardiovascular system, and neurological processes. Thinking in terms
of healing from a bidirectional model improves our resilience with time and
commitment to contemplative practices.
Interoception: Going Inward

With the use of meditation, yoga, Qigong, energy healing, talk therapy, and
many other mind-body-spirit modalities, we can improve our sense of
interoception.9 Interoception is the ability to be more in tune and aware of the
responses of our bodies, allowing us to step into witness mode and choose our
response with more empowered intention. Sensations that create pain,
whether expected or unexpected, can increase anxiety, and this is more likely
to create more pain. Enhancing interoception creates
greater presence in the moment and improves our
ability to craft a better outcome. It involves bringing
Meditation can
our awareness back to our own needs, our own open us up to
bodies, and our emotions. the information
Contemplative practices are the best way to
behind the
enhance interoception, and many options are
available. The option you choose matters less than
curtain of the
the fact that you are working in conjunction with unconscious
others to provide safe space to do this work and mind.
learning applicable tools you can use in individual
practice. Find a meditation style or mindfulness practice you are interested
in—one which will motivate you to show up. The profound aspects of mindful-
ness, contemplation, and therapeutic movement modalities are in the act of
doing them. Each person gets what she needs from the practice in the exact
time she needs to experience it. Your ego is not in charge of the outcome, but it
is in charge of showing up to be witness to the possibilities.
Making Time to Feel

Creating space and time is important to any form of contemplative or mindful-
ness practice. As we start to tune in, we may experience sensations that are
not easy to be with. If we have not listened to our mind-body in a long time,
the body may have accumulated information and may be waiting for permis-
sion to reveal it. Just as we detoxify the body of physical substances, we also
need to detoxify emotionally and mentally. Mental-emotional clutter can
accumulate, adding to our stress, low immunity, and physical pain with
increased inflammation, undesired moods, and poor concentration. This is
more likely to happen if you were raised in an environment in which showing
emotion was considered a weakness or a liability.
Our conscious mind is aware of such a small part of our experience at any
given time, but meditation can open us up to the information behind the curtain
of the unconscious mind. Our inner critic, also referred to as the pain body, can
emerge; it is the part of us that holds feelings of lack, resentment, inferiority,
anger, grief, shame, trauma, and others that enhance pain rooted in fear.
Eckhart Tolle, a modern-day spiritual teacher, coined the term the pain
body. While it sounds ominous, it is the accumulated stagnant energies in a
subtle body of judgment, self-loathing, and other unloving thoughts that can
be felt emotionally and physically. Tolle also alludes to the fact that we can
have an attachment to our pain body, which can be related to a victim mental-
ity, an inability to forgive, and difficulty taking personal responsibility. As you
open up to listening, it’s natural to experience pent-up emotions such as
sadness, anger, victimhood, and overwhelm; and these can be aligned with
areas of discomfort in the body. When energy can’t find a solution or resolu-
tion, it is stored in the body. Unresolved mental, emotional, or physical pain is
retained by the ego mind, which repeats the pattern of pain through our
reactions again and again.
Bring Yourself into

the Now Moment
When we have unresolved trauma, we are straddling the past and projecting
into the future. This means it is more difficult to feel at home in our body in
the present moment. When we project into the future, we cultivate anxiety by
creating stories about what will happen in the future. Usually, we rely on
catastrophic thinking. The mind is creative, and can come up with all sorts of
unbelievable movie-of-the week outcomes. The more we think these thoughts,
the more our brains reinforce them, looping over and over again. One of these
loops can be, “I’m never going to be well again.”
In many cultures, it’s common to make time to cry or for other emotional
release. I recommend that you take time on regular basis to sit, stand, or lie
down in a sacred space you have created. Ideally, this is a place where you
won’t be interrupted. Simply make the statement, in your mind or out loud, “I
am here and available to release feelings or sensations that are beneficial for
healing.” Then breathe and allow feelings to surface. Nothing may happen
initially if you are used to swallowing your feelings as a survival mechanism.
This process creates a space to allow air out of the balloon slowly, with
intention, so it does not build up.
You may start to feel emotions rise through your body as a somatic
experience of sensation, with muscles tensing and relaxing. This is normal as
emotions move out of the tissues and subtle body and detox gets under way. If
the emotions start to feel unsafe or overwhelming, pull back. Bring your
awareness back a few steps. This practice is not about forcing the emotions to
move but about allowing the intelligence of the body-mind to work the energy
through the system. If you have a history of traumatic memories, these may
resurface if they are trapped. In this case, it’s advisable to work with a
counselor to help you process the emotions that emerge.
Self-care, such as establishing regular sleep patterns and eating healthily,
is also very important at this time. Deep emotional work is best partnered
with yoga, Qigong, Tai Chi, exercise, massage, and/or sauna to allow energy to
continue to be released in a healthy way. These exercises also let you partici-
pate in nurturing yourself, which fosters compassion for self. Trauma work is
a practice to undertake when you have social support and can authentically
share the emotions that arise, integrating healing.
Contemplative practices that can be modified to fit anyone’s capabilities
include:
• Meditation, daily or several times per week: You can do guided

meditations, where you listen to others take you on a journey, or
repeat prayer/mantra statements to focus on. You can also do
moving meditation (hiking or dancing) or just be with your breath
in solitude. Meditation is a time to detoxify your mind of thoughts
that have accumulated from stress responses to inner and outer
experiences. The eventual goal is to just be with yourself, your
breath, and your thoughts and to learn to listen internally without
outside interaction. Just as we detox the physical body, we must
detox the mental body, pain body, and emotional body. Everyone can
meditate: You just need to keep showing up to the practice, have a
comfortable place to be, and keep breathing. Start with ten to fifteen
minutes per day.
• Creation of a sacred space: Find a place of solitude at home, at
work, or outside (garden, ocean, hiking trail, bench in a park). It
could even be a chair in the house. This is just a place where you
can sit, signaling that you are in need of time to be quiet with your
thoughts. The intention and the physiological response to being in
the space are both vital. Setting aside a special place is rooted in
ritual and is part of many different spiritual and mindfulness
practices that change the frequency of the brain to a calmer state.
Just by being in the space—with certain smells, colors, pictures,
furniture, sacred objects, stones or crystals, or books that have
meaning for you—you can instantaneously improve your state of
mind. This can become your primary space for meditation or simply
a place to be creative.
• Movement, with yoga/Qigong/Tai Chi/walking/running: As we
move our bodies with intention and purpose, we move stagnant
energy that accumulates in muscles, nerves, lymphatic vessels,
digestive tract, and energetic circulatory systems. This improves the
mind-body connection as well as strengthens the body; movement
can reduce pain and enhance mood through expression of healthy
neurotransmitters. Initially, you may experience growing pains, as
you improve your endurance. Most of the movements prescribed can
be done while sitting or lying down, just moving the limbs, or you
can fully engage with your whole body. Use your own judgment to
discern the best starting point because no one knows you better
than you; but do not be afraid to push out of your comfort zone. Mild
to moderate discomfort is where change will happen. But I do not
recommend any unnecessary suffering in any way.
In Summary
I have seen patients change deeply when chronic Lyme disease goes into
remission. Often, surmounting their challenges leaves them with a deeper
understanding of what they want to do, and new talents emerge. One patient
cultivated the ability to paint, even though she’d previously been so neuro-
logically compromised she could barely speak, walk normally, or pay
attention during our visits. It took her a few years to recover, but she is now
selling her fantastic pieces. Another patient had been overextended, caring
for everyone else to the detriment of her own health. She made the decision
to choose herself by creating better boundaries with others for the sake of
her own well-being. As soon as she did, something changed in her disease
process, and she quickly gained more energy, became more gregarious, and
determined to get well. She had been losing weight, felt terrible pain, and
was neurologically compromised, but her health steadily improved when she
made herself a priority.
Others have felt motivated to create social justice for those dealing with
Lyme disease, creating fund-raising and support groups. Going through the
recovery process enables individuals to take the lessons into their work life,
especially those in the health care field. Most doctors who are outspoken
about tick-borne infections have gone through their own health crisis with
Lyme disease, which focuses their attention toward advocacy, research, and
education. I include myself among these; I had been treating Lyme disease for
several years before discovering I also was infected.
Understanding underlying issues in the psyche can greatly help a growing
population of chronically ill people with tick-borne infection. Let’s change the
focus from chronic Lyme disease as a fictional illness or shameful diagnosis to
one that has potential for healing. The well-known Sufi mystic and poet Rumi
says, “The wound is where the light enters you.” Let’s allow this to happen.
Let’s acknowledge our wounds so we can start to heal them, regain health,
empower ourselves, and move through the world with ease. This must start
with allowing the energy around the situation to change. Chronic illness can
be painful and humbling, but it is the best medicine for healing your life once
you set up a process and support network to help you. If you have been
diagnosed with psychosomatic illness, say, “Thank you. Yes, I do.” Your mind
and body are not separate and never have been. Science is starting to finally
acknowledge this aspect of medicine, and this new attitude will eventually
trickle down into the inner workings of the average doctor’s office.
CHAPTER 11
ENERGY
MEDICINE:
NURTURING
OUR FUTURE
SELVES
edications are external supports intended to improve the health of
M the body. As much as we try to find answers to illness and infection

in a bottle or a machine, we should not ignore the power of the
individual to heal from within. This power has just barely been
tapped into by the majority of the population. For instance, researchers have
discovered that IL-6—an inflammation marker commonly elevated in the
brains of those who commit acts of self-harm—can be decreased by feelings of
“awe,” experienced in states of joy, bliss, contentment, or relaxation.1
Energy medicine is a difficult topic to delve into. It’s a subject that strikes a
chord in people—it either resonates or brings out skepticism. There are so
many opportunities to receive energy healing as a form of treatment—now
more than ever before. New healing centers are opening up, and energy
therapies are being integrated into medical practices, counseling centers,
hospitals, and education facilities. The corporate world, too, has begun to also
incorporate energy medicine by encouraging mindfulness practices during the
workday to improve employees’ mental focus and morale.
206
In this chapter, I discuss my own journey into the energy medicine
world, offer scientific validation of energy therapies, and offer an overview
of shamanism, Reiki, and other energy medicine, showing the benefits of
incorporating them into your Lyme disease treatment plan.
My Story
Many patients ask how I got into energy medicine. I have always been
intrigued by the science behind the mind-body connection. My interest
started at the age of nine or ten with a fascination of accounts of near-death
experiences, most likely propelled by the death of my mother when I was
seven. Like many children, I was very sensitive, but I learned to suppress the
things I somehow knew, my deep feelings of empathy for others, and the
things I saw and heard that I could not explain. I also found it difficult to relax
into these experiences while feeling deep grief in the early years of my life.
The mystical experiences also scared me. I was not taught how to be in
harmony with them, so I felt overwhelmed. Throughout most of my childhood
and young adulthood, I suffered intense social anxiety and was painfully shy.
I suppressed a lot of myself and did not really embrace who I was until I
experienced a Kundalini awakening in my mid-thirties.
This awakening started with a profound experience during a meditation
where I left my body and expanded in a bliss state, hearing clearly the statement,
“Remember who you are.” I took days to return to normal. A few weeks later, the
feeling came back even stronger, with an intense sensation shooting up my spine,
waking me out of sleep. I went through a difficult time trying to understand the
overwhelming number of physical, mental, emotional, and spiritual experiences
that were happening simultaneously. This went on for many months.
I was experiencing something Stan Grof, M.D., Ph.D., researcher and
author, refers to as a spiritual emergency or psychospiritual crisis. A psycho-
spiritual crisis is one in which a person’s self-concept and place in the world
completely shift after a spontaneous mystical experience. This is a transfor-
mational experience, evolutionary and healing, though it was hard to see it
like that while deep in it. Many people have gone through this process or are
going through it now.
It was difficult to maintain my daily life of medical practice and mother-
hood. Some days, I was not functional at all and hid away, desperately wanting
solitude. Caroline Myss, a well-known medical intuitive and author, gave a
great lecture titled “Spiritual Madness,” in which she discussed the phenome-
non of energy openings in the modern world. Historically, when people
207
experienced spiritual events like the one that happened to me, they would have
gone to a monastery, abbey, or ashram to find solitude. It is much more difficult
in the modern world to find space for solitude while maintaining a routine life.
Initially, I investigated both physical and psychological reasons for my
experience. I had spinal taps, CT scans, blood work, and MRIs. I was at first
concerned that I had had a stroke or a brain injury from the Lyme disease. I
was having visions, receiving auditory information, and having physical
sensations, pain, and body movements with spontaneous yoga postures, which
frightened me. At the same time, I knew I was moving through something that
was ultimately benevolent in nature. I consulted with medical practitioners,
priests, psychologists, and energy healers and read as much as I could to figure
out how to make it stop. But it didn’t stop, so I surrendered to the process.
It took me a while to understand I was having a mystical, physical,
emotional, and psychological experience all at the same time. With the help of
a knowledgeable circle of support, I was able to put myself back together with
a new transpersonal understanding and healing abilities. Since this shift, I
devour books on energy healing and have attended multiple trainings in
energy-healing modalities for my own benefit and so I can integrate them into
my medical practice.
I’m a lifelong student and a work in progress. I hope this personal revela-
tion is helpful to others in some way. It’s difficult to convey the magnitude of
these experiences, as most people who have had them will tell you. Once you
try to explain the mystery, it loses potency and gets watered down. I know this
chapter is a radical departure from the rest of the book, but it is near and dear
to my heart as well as big part of my medical practice.
Working with an Energy

Medicine Provider
Lyme disease treatments involving energy-healing modalities are becoming
more and more common, among them color therapy that exposes the blood to
different colors in the light spectrum, magnetic therapies that change the
movement of ions in the body, sound therapy with crystal healing bowls that emit
healing frequencies, medical intuition, shamanic healing, healing with intention,
different forms of yoga, flower essences, homeopathy, meditation, and Reiki. In
addition, there are rife machines, which introduce healing frequencies through
special amplifiers and coils placed on the body, as well as machines that can test
the body’s reactions to different remedies to find the most auspicious
combination for healing. The motivation in seeking out
these therapies with an open mind is a desire to heal.
When you are working with a practitioner in an
The motivation
energy session, you are learning—and not only what in seeking out
can be read or spoken. Energy work is an education these therapies
of listening and experiential learning for all
with an open
involved. A session is a time and place to learn how
to acknowledge emotions and physical sensations
mind is a desire
while working with the subtle states of energy. Your to heal.
energy is transformed by the space created between
you, the practitioner, and universal energy. There is infinite potential for
change. You may need just one appointment with an energy-healing practi-
tioner to set you on the path to healing. Others, myself included, may have
multiple sessions, peeling away layers over time in a learn-as-you-go method
taken at your own pace.
As I work with patients in energy-healing sessions, which are distinct from
standard medical office visits, I use an amalgamation of the modalities I’ve
studied over the years. This results in a unique experience each time. I’m very
kinesthetic, experiencing energy in my physical body. I have an inner physical
knowledge of where to place my hands over a patient’s body and use a blend of
sight, sound, and touch as needed to provide information that is helpful for the
patient. Rather than doing the healing, I act as the conduit for the energy flow
that assists the process. Each meeting is different and depends on the needs of
the individual seeking help and what is best for her at the time of the visit. I
strive to create a safe space, work with integrity, and never take away a
patient’s personal power.
Patients have shared amazing stories of synchronicities, clarity of thought,
a better relationship with their own bodies, beautiful mystical experiences,
beneficial dreams, profound changes in family dynamics, and self-
empowerment. Energy healing can be done in conjunction with medications—
there is no need to choose one over the other—and it embraces and honors any
tradition or belief system. These sessions can help to reduce Herxheimer
reactions, improve coping skills, induce deeper healing of past trauma, aid in
detoxification, calm the nervous system, and offer many other benefits.
You might see a wide variety of costs associated with energy treatments as
well as promises of a cure. This type of treatment requires more discernment
from consumers, who must consider legitimate business practices and the ethics
of energy healing—patients need to be savvy about navigating this world without
becoming mesmerized by the magic and mystery. Always ask about a practi-
tioner’s training, methods, and how he views his role. A practitioner who
cultivates fear to create more drama is not going to be a healthy choice; energy
E N E R G Y M E D I C I N E : N U R T U R I N G O U R F U T U R E S E LV E S 209
healing requires that a provider be authentic without overanalyzing the informa-
tion, fortune telling, or disempowering the client by claiming superiority.
Where Science and Spirit Meet

The field of quantum physics offers a bridge between material reality, such as
our bodies, and a reflection of universal energy. Albert Einstein once referred
to the ability of one particle to communicate directly with another at a great
distance as a “spooky” event; known as quantum entanglement, this has now
gone beyond theory and is a proven physical phenomenon. Plants can compute
using quantum mechanics during photosynthesis. They preferentially absorb
the most beneficial color particles in the light spectrum, which move through
the leaf with a single photon particle simultaneously in more than one place at
a time. The plant does this for survival, finding the most efficient pathway for
light to reach it destination, becoming 100 percent energy efficient. 2
In peer-reviewed research, energy healing modalities are referred to as
biofield therapies, defined as “gentle, noninvasive therapies that work in the
human energy field.” The term biofield was introduced at a conference of the
U.S. National Institutes of Health in 1992. Biofield therapies have since
branched into various medical applications, including biofield physiology, in
which energy fields code information and provide instructions that influence
biological systems, such as the magnetic fields generated by the heart cells. 3
Biofield therapies cover a wide variety of modalities, including Qigong,
yoga, hands-on healing, power of prayer (intention), acupuncture, the external
use of magnets, flower essences, homeopathy, Pranic healing, shamanic
healing, and many others. A study published in the journal Alternative Thera-
pies in Health and Medicine reported that biofield therapies reduced pain and
tenderness in the body while improving depression in patients diagnosed with
fibromyalgia to a degree that allowed a majority of participants to reduce their
medication use.4 Therapeutic touch is recognized in hospital settings, where
it’s now common to have Reiki practitioners work with patients to reduce stress
and improve recovery rates. In the 2012 National Health Interview Survey
conducted by the U.S. Centers for Disease Control, 3.7 million people replied
yes when asked if they had ever seen an energy-healing practitioner.5 I would
guess that this number is even higher now, with chronic disease on the rise
creating a trend toward alternative therapies driving the marketplace.
As technology has improved, we are able to prove the existence of the
auric field or light fields radiating from all living beings, which are referred to
as biophotons. Biophotons are ultraweak photonic light emitted from biological
systems as luminescence; they are not related to heat but change based on
stress on the living system. Fluctuations in biophoton emissions have been
found in relationship to cerebral blood flow and energy metabolism in the
brain. Understanding their function could lead us to ways to observe imbal-
ances medically before they manifest as physical illness.
Biophotons were first discussed by Alexander Gurwitsch, who believed
that fields of energy governed physical development. He called these morpho-
genetic fields and posited that cells interact with each other to develop specific
organ systems or draw together to complete a task. This idea was later
expanded by physicist Fritz-Albert Popp, Ph.D., who revived the concept after
using more advanced technology to witness light emanating from tissues.
Accessing the Collective

Unconscious for Healing
Rupert Sheldrake, Ph.D., a cell biologist and author of several books and
articles, hypothesized the concept of morphic resonance fields, shared fields of
information that hold inherent memories. A morphic resonance field allows an
underlying nonverbal understanding of a collective unconscious shared by
members of a species or group.
The collective unconscious, a term coined by one of the fathers of modern
psychology, Carl Jung, is data that informs the physical world using arche-
types, or universal patterns and images. Think of it like a spiritual Internet.
Our minds are able to respond and change based on data that are part of our
larger cultural knowledge base, even though we might look at something and
feel we have no understanding of it—it’s what we might think of as instinct or
as recognition of a universal symbol.
The concept of archetypes was best illustrated to me through a healing
method I studied called the Mora Technique 7 Layers of the Heart, developed by
shamanic practitioner Esther Mora, D.D., D.MT. It involves using archetypal
images, which can include mathematical equations rooted in physics, binary
code sequences, chemical structures of medicinal plants, sacred geometry, and
many others. The higher aspect of the mind connected with the collective
unconscious understands how to use the data to improve mental, emotional, and
physical balance. It begs the question: Do we always need to take medications
into the body to create change? Can we heal the physical body instead by
accessing the collective unconscious or morphic fields? This is fascinating
stuff—and it means we have more healing power within than we realize.
Quantum Dosing of
Nutraceuticals
IN CERTAIN PRACTICES, SUCH AS SHAMANISM, everything is alive with
consciousness and spirit, including plants. Working with the energy fields of
consciousness can enhance the healing potential of plant-based medicine by
working with intention to ask for healing from the consciousness of the plant.
I typically have on hand an herbal combination in capsule form to support
the adrenal glands, with ashwagandha, licorice root, holy basil, and rhodiola. I
use these herbs as an example; you can use whatever you have at home, as long
as it is plant based. Take one or two pills in your left hand (you may feel a pull to
place them in your right hand, which also works). Before you swallow the
medication, sit with the capsules in your hand. Ask for the plant intelligence or
its archetype to work with you to allow healing to go where it is most needed
within. Then thank it for its assistance.
You may feel movement, heat, and tingling in your mid-back, where the
adrenals are located. If you don’t feel anything, it does not mean the intention-
setting is not working, but I know it makes it easier to connect with the process if
you have some confirmation. You can then take the pill internally. I would caution
you to use this method only with homeopathic remedies, flower essences,
nutrients, and other forms of plant medicine found in the natural world. Don’t try
this with pharmaceuticals, though you can ask the body to resonate with any
medication before you swallow it, to help create balance. Plants are our greatest
medicine, teachers, and food resources on the planet. Without them, we could
not survive. If you want to know more about this topic, look for one of the many
books referencing plant spirit medicine, or consult the HeartMath Institute for its
research on plant intelligence with the “Interconnectivity Tree Research Project.”
Our Energy Anatomy

Energy anatomy is a more significant part of our lives than we acknowledge.
Crediting its role and learning to work with it is a game changer for our
health, communication, emotional responses, cognition, and quality of life.
One of the most ancient forms of medicine, now common around the world,
acupuncture works within the subtle energy field of the body’s meridians,
mapped out by healers and doctors over centuries. Meridians are aligned
with other aspects of energy anatomy, the chakra system and etheric/auric
energy fields.
It’s helpful to have a basic understanding of our energy anatomy. There are
many different schools of thought, which use different terminology. The
specific layers of energy radiate from the body—you can think of these like the
layers of a Russian nesting doll. You keep removing the outer layers until you
find the physical body at the center. The energy anatomy briefly discussed
here are the chakras, the meridians, and the etheric body.
Commonly referred to as Prana or Qi (Chi), the energy breathes in and out,
informing our cells and DNA as it moves through a refined mesh and duct
system aligned with organ systems. The areas in which this energy is concen-
trated are referred to as chakras, now a fairly familiar concept in our Western
vernacular. The term chakra refers to a spinning wheel of energy concentrated
at specific points in the body. The seven major chakras are aligned with the
glandular system along the spinal column, although there are many more
minor ones. Each chakra has a particular function, movement, sound, color,
relationship with our mental/emotional body, ancestral connection, immunity,
and soul life. Eastern medicine modalities have a more integrated approach to
the energy meridians and medicine than Westernized medical practices do.
Chakras have been mapped out over centuries, and these lines of force are
used by acupuncturists to restore flow of our energy within the etheric body,
which is not separate from other aspects of energy anatomy.
The etheric body sits right against the physical body, with intricately
woven threads or lines of force communicating directly with our cellular
structure as well as receiving outer energy information. The etheric body
holds our memories and ancestral information. For instance, phantom limb
sensations experienced by those who have lost an arm or leg are related to the
etheric body. The continued awareness of the limb and sensations in the
absence of the physical body part is due to the energetic limb still being
present and experienced by the nervous system through the etheric blueprint.
Plants, minerals, or animals, when exposed to high-voltage electric field
energy, emit a light energy residue. This is well documented with Kirlian
photography, discovered by Russian scientist Semyon Kirlian in 1938. When
parts of plants are removed, for example, the image of the original physical
form remains in subsequent photos. This represents visual proof of what
amputees experience physically, the presence of the etheric energy map,
which underlies physical structure and is still associated with the structure
even though physical parts are missing.
Energy flows into the etheric field, which then informs our physical cells
and affects the body’s response, becoming part of our physical experience. If
the etheric body is storing unhealthy energy from electromagnetic smog put
out by cell phones, emotional wounds, ancestral trauma, or individual trauma,
or is holding any data that do not resonate with healing, the physical body’s
quality of life is affected, making it more susceptible to disease. If the quality
of life in the body is poor, the mental/emotional state of the person is affected,
perpetuating a vicious cycle. All energy modalities, at their core, attempt to
remove blockages to energy flow, whether the obstruction is rooted in mental/
emotional blocks, toxic body burden, microbial interactions, or nutritional
imbalances. Once flow is reestablished, the body can more readily remove
toxins, create balance with microbes in the body, reduce stress, and restore
proper function for improved quality of life.
For a deeper dialogue on energy anatomy, I suggest reading Barbara Ann
Brennan’s book Hands of Light: A Guide to Healing Through the Human
Energy Field or Caroline Myss’s Anatomy of the Spirit: The Seven Stages of
Power and Healing.
Creating a New Relationship

with Microbes
The Gaia hypothesis, developed by scientists James Lovelock, Ph.D., D.Sc., and
Lynn Margulis, Ph.D., in 1972, states that Earth is an evolving, interconnected
living system that is continually finding solutions to maintain homeostasis.
Microbes inhabited the planet 2.1 billion years before there were any signs of
animal or plant life,6 and the bacterium that causes Lyme disease has been
shown by genetic sequencing to have been in the United States between
twenty thousand and sixty thousand years ago.
Dr. Margulis, a biologist, researcher, and author, also coined the term
holobiont to describe the relationship of the human, animal, or plant to its
microorganisms. Years later, the name hologenome was brought forth by
scientists Eugene Rosenberg, Ph.D., and Ilana Zilber-Rosenberg, Ph.D. 7 The
hologenome is made up of the total genes of the host and all its symbiotic
microbes. These are in relationship passed from generation to generation as
well as transmitted horizontally via other humans, ticks, animals, and the
environment (through water, air, and soil). There can be subtle or more
dramatic changes in the hologenome, depending on what’s required for
survival. The key to our adaptability on Earth is our interrelationship with
microbes because of the ability of their genomes to change more rapidly
than the human genome does. Thus, microbes are our informers and our
problem solvers.
Lyme disease is referred to as the disease of the soul in a healing modality
called microbioenergetics, developed by Miguel Ojeda Rios, M.D.
Microbioenergetics is an amalgam of microbiology,
embryology, neurology, epigenetics, bioenergetics,
New Germanic Medicine, Biomagnetic Pair Therapy
Changing your
(application of magnets to change pH in body to relationship
resolve physical imbalances), psychology, Family with the
Constellation Work, muscle testing, and more. This
microbe and
modality is a dynamic, ever-evolving practice that is
too immense to cover in detail here. There are many
learning to be
parallels with the work of Dietrich Klinghardt, M.D., in harmony with
Ph.D., and his applied psychoneurobiology courses it starts by
through the Klinghardt Academy. Both doctors have
changing your
been profoundly helpful in expanding my approach
to the complexities of diseases such as Lyme disease
relationship
by offering a road map to help find the core of the with yourself.
individual’s connection with his energy field and the
disease causing suffering.
Microbioenergetics is about finding a way to understand where the human
being and the microbe meet within the body from an emotional perspective;
then trying to understand how this interaction is fostering illness in the
individual. Changing your relationship with the microbe and learning to be in
harmony with it starts by changing your relationship with yourself. This is
related to the Law of Attraction or Law of Mirroring, which looks at what
inside us attracts that which is outside of us, creating an energetic resonance.
If something resonates with us, we create a relationship with it. Once that
resonance is gone, the relationship has no purpose anymore and it changes.
Why is the microbe making a home in us? What does it have to teach us? As we
go deeper into these questions, we may find past traumas, emotions, and
beliefs that are in alignment with illness.
Microbioenergetics uses the art of asking questions with applied kinesiol-
ogy to get direct information from the higher intelligence of the mind-body
connection. This is done by asking yes or no questions, then interpreting
changes in leg length, usually in the right leg; this is information sourced from
a deeper interpersonal knowledge, associated with the right brain rather than
the analytical left brain. When working with the higher intelligence of the
body aligned with the universal energy field, we can find answers unfettered
by our doubts and personal filters.
The main goal is to identify a personal conflict, conscious or unconscious,
that is aligned with a particular microbe. Conflicts are rooted in primal needs
such as those for food, land, shelter, safety, love, and water. Conflicts in the
modern world may center on lack of job, lack of love, or loss of a home.
However, the core aspect of these conflicts are rooted in primal survival
needs. Once this information is brought to the
surface, we have an opportunity to change the
Lyme disease relationship with the microbe by healing our inner
has the ability wounds, by merely bringing inner information into
to poke you the awareness of the conscious mind, which then
emotionally and prompts a release from the body. This release can be
mental, emotional, physical, or at the soul level.
root out feel- When a patient has failed multiple treatment
ings you had regimens, I commonly ask patients in my initial
stored away for microbioenergetics session, “Do you want to be
well?” When I ask this, the person looks at me with a
self-protection.
raised brow and says of course they want to be well.
Why else would they be here, participating in this
process? Then I ask the body, and the body says, NO. Shock shows on the
patient’s face, as she doesn’t understand how that could be. We have more
power than we acknowledge to alter the course of our biology. If a patient has
unconscious feelings of inadequacy, undeservedness, punishment, guilt, or
shame, or holds beliefs handed down through generations, her unconscious
choice has a profound impact on her health. This could be why the multiple
therapies she has tried have failed. Rather than the medicine, her unconscious
choice may be dictating the course of the disease. Once this belief is brought to
light, the biological energy aligned with it changes and is no longer supported.
Then the biology changes, based on the new belief, and is more receptive to
healing. This is just one example of a potential reason that recovery from
Lyme disease can be difficult.
To circle back to Lyme disease as a disease of the soul, it seems this
intelligent microbe could have the job of collective catalyst, bringing forth
inner fears so we can experience the gift of releasing them. These are deeper
fears carried within societies, communities, and cultures. Lyme disease has a
way of shining a spotlight on the shadows buried within. I always found it
interesting that one of the cardinal homeopathic remedies for Lyme disease is
aurum (gold), the most coveted illuminated metal on the planet. Aurum is also
a remedy for dark thoughts and feelings.
Your emotions can become erratic not only due to neuroinflammation but
also because of hidden feelings such as repressed anger, sadness, grief, shame,
and fear. Your ability to trust others, to feel safe, and to have faith in your body
will be triggered and tested during the process of recovery. Lyme disease has
the ability to poke you emotionally and root out feelings you had stored away
for self-protection. These stored emotions can become toxic and work against
you if they are not resolved.
Reconnecting with Our
Personal Power: Shamanism
Energy-healing modalities can help us expand self-knowledge, find personal
power in a disempowering situation, and heal not just from physical com-
plaints but from psychological stressors as well. Energy medicine also is a way
to reorient our relationship with our bodies, the environment, and our family
dynamics. It provides an opportunity to go inward and search for our own
unique answers to our health crises, in conjunction with external medications.
The goal of these modalities is to remove impediments to health so the body
can do what it knows how to do—return to balance, create deeper states of
peace and hope, and enhance personal power. Energy-healing modalities can
make healing more efficient but are not meant to take the place of other
medical interventions; instead, they can work alongside any path a patient
takes on his personal healing journey.
I have observed enough individuals moving through chronic Lyme disease
to notice a pattern in which the ability to retain old suffering is no longer
possible. If a person continues to resist her pain and suffering, the illness
manifests on a grander scale. These shadows can create tension within,
leading to disease. Shamanic healing arts offer another way to relieve this
tension, to let go of repressed energy and bring harmony into areas of discord.
The difficulty with any healing journey is finding patience with the process
and being able to trust the information given in a mystical experience, which
is usually given in metaphor, either through direct experience or through a
practitioner tuning in to get information on behalf of another.
Shamanism has been around for tens of thousands of years, but its
traditions were historically kept closed, shared only by word of mouth with
those initiated into the practice. Shamanism has traditionally been embraced
by cultures that feel a deep sense of connection to the planet and their
community, and to the plant, mineral, and animal kingdoms. One could argue
that this connection has been lost in the modern Westernized world, leaving a
sense of separation from nature. In shamanic practice, everything has
consciousness, and everything is connected. Sentient beings include plants,
minerals, microbes, the elements, the animal kingdom, and Earth herself.
A shaman is one who can walk between worlds, with one foot in ordinary
reality and the other in nonordinary reality, accessed in deep states of
meditative journey. Shamanic practitioners learn techniques to access
nonordinary reality through the power of focus, intention, will, and prayer,
which cultivate deeper meditative states. A spiritual practice rather than a
religion, shamanism can be woven into any tradition or belief system. It’s also
a partnership with helping spirits and higher intelligence as the guiding force.
This idea of being in service is part of almost every spiritual practice,
cross-culturally.
Shamans are typically initiated through a crisis; this can be a health crisis,
a near-death experience, or a mental-emotional crisis, or it can be a sponta-
neous opening to nonordinary realms through meditative practices. The
process of moving through tick-borne infection can be a form of initiation.
Initiation is the process of walking through a painful trial and coming out on
the other side stronger and more spiritually mature.
Healers use common shamanic practices referred to as shamanic
journeying and shamanic ceremony. We can all cultivate these skills. The goal
is to become the “hollow bone”—essentially, a conduit—by clearing your
mind of daily mundane thoughts and allowing higher information to come
through. Shamanic practitioners usually use a drum, rattle, or dance to
encourage thoughts to fall away and to permit deeper listening. As you
become more skilled in the practice, you learn to get into a receptive state
much more quickly.
Those who practice shamanism journey on behalf of themselves, another
individual, a group, or the land to access healing information; but shamanism
is also is a way of connecting with our ancestral lineage so that we can heal
family patterns—for our own benefit but also for our descendants. The role of
the client receiving healing is to remain receptive and calm. The role of the
shamanic practitioner is not to analyze data but to allow information to be
relayed authentically in a way that cultivates a healthy outcome. It’s a dynamic
creative practice with many applications and methods, always changing to
stay relevant in a given culture and time. Shamanic methods are used in
medicine, psychology, sociology, and in areas of commerce. These practices
and tools are accessible because individuals have been able to meld traditions
of shamanism with Western conventions.
My motivation in discussing shamanism is to foreground its relevance to
our health care system, where illness has many causes, including a loss of
power. Diseases are treated in the body with medications, but if the core cause
is a broader issue, finding profound levels of healing may be challenging.
Shamanism is not about guaranteeing a miracle, but it can produce profound
shifts that improve health. Reconnecting with the sacred and working with
the energy available in the universe for healing is the primary motivation in
shamanic practice. It’s about self-care, personal responsibility, compassion,
and connection with all beings as a unified system. It is not a new way of being
but rather a remembering of who we are.
Shamanism aligns beautifully with the tenets of naturopathic medicine, in
which the doctor is teacher and helps channel the healing power of nature.
Many shamanic teachers I have worked with have trained with the Founda-
tion for Shamanic Studies, founded by the late Michael Harner, Ph.D. His
books The Way of the Shaman and Cave and Cosmos: Shamanic Encounters with
Another Reality are excellent resources for exploring shamanic healing
practice further. I never had the opportunity to meet Dr. Harner, but I’m
grateful for his work in bringing shamanism into Western culture. Another
fantastic resource are the books of one of my teachers, Sandra Ingerman:
Shamanic Journeying: A Beginner’s Guide, Walking in Light: The Everyday
Empowerment of a Shamanic Life, and Medicine for the Earth: How to Trans-
form Personal and Environmental Toxins. There are many different lineages in
shamanic practice, with teachers around the world; there are also plentiful
opportunities for online learning.
Reiki
Reiki is a form of healing that originated in Japan. Rei means “higher power”
and Ki means “life force.” Thus, Reiki is the laying on of hands, typically via
hovering of hands with intention: It’s working with the intention and source
energy that moves through all beings. Reiki connects us directly with universal
energy flow. Those attuned to Reiki set the intention to allow the life force to
flow where healing is needed, assisting in relaxation and stress reduction. As
with most forms of energy work, it can be done in conjunction with other
modalities within larger institutions such as hospitals, hospice facilities, and
rehabilitation centers as well as practiced on an individual level. In a study
published in 2018, meta-analysis validated the analgesic effects of Reiki,
revealing that it has a statistically significant impact on patient reports of pain.8
This healing energy is available to everyone, within everyone, and is safe
to use with any form of medicine. I frequently refer patients to Reiki classes if
they have an interest in energy-healing modalities, as they can gain a valuable
framework for energetic self-care, or energy hygiene. Energy hygiene is a daily
practice of tuning in to and clearing our energy and is just as common as
taking a shower or brushing your teeth. As with any energy modality, once a
person is attuned to energy via Reiki, he can use it to help others as well as for
self-healing. I am specially trained as a Reiki Master in Usui/Holy Fire Reiki,
based on William Lee Rand’s method. There are many different lineages and
styles of Reiki, and teachers and classes are available on every continent if the
experience calls to you. For more information, visit www.reiki.org.
Energy-Clearing Symptoms
AS YOU IMPLEMENT CHANGES using energy-healing methods, you might
believe that rainbows, butterflies, and unicorns will automatically follow. I don’t
mean to be the bearer of bad news, but detoxification symptoms, which we’ve
discussed throughout this book, can result from processes other than Lyme
disease. Clearing mental, emotional, or energetic trauma can cause symptoms in
the body, and if you are not educated about this fact, the symptoms can induce
fear, which is counterproductive to the goal of healing. I explained some of my
own difficulty with this process at the beginning of the chapter.
When you start to dig deep with energy modalities, you may bring forward
energy that needs to be detoxified. This may come as spontaneous emotional
release of negative thoughts or old memories, physical sensations from energy
stored in the fascia, or a literal release of toxins in the form of diarrhea. When
you feel this intensity, it is best to breathe, let go of tension in your body, and
act as an observer, watching your release with compassion. A statement that
works well for me in these moments is this: “This is the most loving thing that
can happen.” I will repeat this sentence like a mantra as the uncomfortable
sensations move through and out. This release is not about forcing anything to
happen; it’s about your ability to be with what is uncomfortable, allow yourself
to feel emotions, and watch them pass through.
I needed help from others and some practice to learn how to allow the
process instead of resisting it out of fear. The body will implement the most
efficient way to release stagnant energy through your meridians, your emotional
body, and chakra system; but when the analytical left brain kicks in with worries
about the process, psychological ailments, and medical diagnoses, it can bring
the process to a halt. Understanding this as a natural process of self-healing can
help you step into self-care and determine your limits, understanding that you
need to pull back if you touch on emotions or memories that are too intense to
handle in the moment.
It is wise to have support medically and psychologically to maintain your
ground through the process until you feel you have regained more solid emotional
and physical health. Eventually, over time, you can find a more peaceful state of
mind, and your baseline for what triggers a stress or fear response will change.
You can become more in tune with others if you develop unity consciousness, the
feeling of being connected, supported, and in tune with your own intuition, with
access to physical energy and creativity. The more we clear our conscious and
unconscious fears, the less room there is for disease to manifest. The idea here is
that if you change yourself, you will improve your personal relationships and those
with the broader community in ways you may not even be aware of.
In Summary
I have specialized in tick-borne disease for more than a decade, and I’ve spent
years opening up to the challenges of each case, looking for protocols to treat
the infection and offering sincere help for my patients. I also learned much
from my journey healing from tick-borne disease myself. I have studied and
worked with many modalities to find the path of least resistance to recovery.
I love naturopathic medicine because its boundaries are fluid. Many of our
standards are identical to those of conventional medical practitioners with
regard to medical ethics, licensure, standards of education, and patient
privacy. Naturopathic doctors are frequently misunderstood, dismissed as
unqualified, or, in my case, demonized for treating tick-borne disease.
The trade-off is that there is a lot of creativity in my profession, and we
weave together all forms of medicine, aiming for the patient’s highest good.
Many practitioners in different fields, some very conservative, are open to
integrating energy medicine modalities into their medical practice. I feel that
more profound healing is possible when all forms of medicine are integrated,
making all modalities available for those who want and respond to them.
Energy healing is just another tool that lets us reconnect with our power and
enhances our ability to experience peace, reduce pain, improve clarity, and be
open to infinite possibilities. This is how we rise above Lyme disease.
REFERENCE
CHARTS
The Foundational
Naturopathic Treatment Plan
Following are basic elements that form an effective treatment plan for chronic
Lyme disease.
• Probiotic supplement that provides 200–400 billion colony-forming

units (CFU); take at lunchtime and before bed. This supplement needs to
be taken at a different time from antibiotics—at least two hours before or
after. It can be taken on empty stomach or with food. You may need to take
higher or lower dose depending on the reaction of the gastrointestinal tract.
The goal is to have regular bowel movements daily and no signs or symptoms
of a yeast infection.
– Konjac glucomannan: A natural dietary fiber, this supplement offers
protective benefit to the gut with antibiotic use. It is most supportive to
Bifidobacterium species (beneficial bacteria) against the use of penicillin
and tetracycline medications.1
222
• Herbal antimicrobial formulations. The best formula for you is based on
your individual needs, and may be either a single-herb form or a combination
formula. The most commonly used formulas in my practice are Byron White
Formulas, Bio-Botanical Research, Beyond Balance, Research Nutritionals,
Xymogen, Lyme Core Protocol, Gaia Herbs, Green Dragon Botanicals, Wise
Woman Herbals, Nutramedix, and Herb Pharm.
• Detoxification support formula. This is to assist the liver and gastrointes-

tinal tract in moving toxins out of the body. It is important to have a combi-
nation of herbs to assist in maintaining healthy hepatocytes and improve
flow of bile to release toxins. Bitter herbs (dandelion, burdock root, arti-
choke) and nutrients to enhance glutathione (cysteine, glutamine, and
glycine) will typically be a part of the formulation. Detoxification support
can also be in the form of a binder such as bentonite clay or activated
charcoal, but be careful to take these away from other medications, as they
can significantly decrease absorption.
• Adrenal support. The type of support the adrenal glands need depends on
whether the glands are to be calmed down or enhanced so their function
returns to a healthy level. Those that enhance function are most commonly
used; these are taken in the morning.
• Biofilm busting herbals or proteolytic enzymes (serrapeptase, lum-

brokinase). Take on an empty stomach and at least two hours before eating,
if possible; it’s best to take it daily, even if you must take it with food.
Breaking up biofilm allows the antimicrobials and your immune system to
more effectively treat your infection.
• Anti-inflammatory herbal combination. The main reason we feel

symptoms physically is the body’s upregulation of pro-inflammatory signals,
called cytokines. Many natural remedies can reduce the production of
cytokines, which benefits the musculoskeletal system, neurological system,
and cardiovascular system.
– Herbal antifungals: Herbal antifungals combat the overgrowth of yeasts
and other funguses in the body. A dose of two to four capsules per day
is typical for the majority of formulas on the market, including gentian
violet, caprylic acid, pau d’arco, and berberine.
223
ANTIFUNGAL NUTRIENTS
NUTRIENTS DOSING/BENEFITS
Allicin (garlic) One 200–600 mg capsule two to three times per day
(caution with taking blood thinners)
Berberine One 500 mg capsule two to three times per day
Caprylic acid 1,000–2,000 mg one to three times per day thirty
minutes before eating
Curcumin/turmeric Range is 18–90 percent curcuminoids, dosing is
product specific, but look for higher curcuminoid levels
Magnolol (Magnolia officinalis) 200—400 mg (can cause drowsiness, used also as a
sleep aid and stress-reducing herb); breaks up
biofilm created by yeast and ruptures the cell wall
of yeast buds2
Neem (Azadirachta indica) One 500 mg capsule two to three times per day, with
20 percent active ingredient
Pau d’arco 1,000–4,000 mg two to three times per day, for one
week
Saccharomyces boulardii One 250 mg capsule one to two times per day with
antibiotics
COMMON HERBS AND NUTRIENTS USED FOR DETOXIFICATION SUPPORT

HERBS AND NUTRIENTS DOSING/BENEFITS
Alpha lipoic acid Dosing recommended at 600 mg three times daily. 3 Helps
support liver under oxidative stress due to exposure of
heavy metals, alcohol, and other forms of poisoning
Berberine Reduction of elevated liver enzymes4
Burdock root Hepatic tissue protection with acetaminophen overdose5
Fish oil and black cumin seed Study showed the combination of black cumin seed oil and
oil combination fish oil showed great promise as a hepatoregenerative
formulation as well as protective to the kidneys.6
Globe artichoke Assists in regeneration of liver cells,7 enhancing bile flow,8
(Cynara scolymus) anti-hyperglycemic properties9
Green tea extract Hepatoprotective and supports healthy liver enzyme levels
in those with nonalcoholic fatty liver disease10
Hoxsey-like Formula Start at one drop per day and work your way up to maxi-
(Red clover, licorice, burdock, mum of thirty drops per day added to water. Best when used
Oregon grape, cascara, with medical management with your practitioner. This is
buckthorn, poke, queen’s root, not meant for long-term use. Advise no more than two to
prickly ash, wild indigo, three weeks at a time with two- to three-week breaks.
potassium iodide)
Licorice root Antiviral especially with hepatitis but also herpes type I/II
(Glycyrrhiza glabra) and cytomegalovirus. Also adrenal supportive due to
having similarity to chemical compound of adrenal
hormone. Has shown ability to regulate liver enzymes in
times of hepatic stress. Can be applied topically for viral
lesions such as shingles11
H E R B S AN D N UTR IE NTS FO R DE TOXI FICATION (continued)
Milk thistle Dosing 100–400 mg in divided doses daily with food. Ideally,
80 percent standardized silymarin.12 13 Antioxidant prevent-
ing toxins from entering liver cells14
Sho-saiko-to (Combination of Two to four capsules per day dosing away from
bupleurum, pinellia tuber, food. Enhances liver regeneration, important
Scutellaria root, ginseng, remedy for cirrhotic liver, heals medication-related injuries,
jujube, licorice, and ginger) enhances natural killer cells, prevents malaria and fevers15
Swedish Bitters ½–2 teaspoons one to two times per day to stimulate bile
release and stimulate proper digestive function
Triphala Rasayana, Emblica Dosing recommended at 500–2,000 mg daily. Detoxifier of
officinalis, Terminalia the colon, healing for chemical-induced liver impairment 16
bellirica, Terminalia chebula
Turmeric (curcumin) Dosing recommended at 200–600mg three times daily of
standardized extract in capsule form.17 18 Enhances bile flow
and supports healthy digestive lining19 20
Yarrow (Achillea millefolium) Hepatoprotective, anti-inflammatory
ANTIMICROBIAL HERBS
HERBS BENEFITS
Andrographis paniculata Antibacterial, antifungal, liver protective, antiparasitic,
anti-inflammatory, immune stimulating. Anti-malarial
activity (Babesia species). 21 Inhibits quorum sensing22
Armoracia rusticana Antibacterial, antifungal, antiparasitic, anti-inflamma-
(Horseradish root) tory. 23 24 Reduces biofilm. Effective against oral Candida
albicans (thrush)25
Astragalus membranaceus Antiparasitic, antifungal, anticancer. Synergistic effect
when used with atovaquone (Mepron). 26 Inhibits
pro-inflammatory cytokines.27 Anti-biofilm properties
when used with Astragalus angulosus28
Artemisia annua Antiparasitic, antifungal. Essential oil has antibacterial,
anti-inflammatory, and antifungal properties (topi-
cally). 29 Artemisinin used globally as anti-malarial
medication, enhancing the activation of common
pharmaceutical medications such as artemether/
lumefantrine (Coartem).
Bacopa (apigenin) Neuroprotective, anti-inflammatory, antibacterial,
antifungal. Contains active ingredient apigenin, shown
to enhance the effectiveness of ceftriaxone and
ampicillin. 30 Bacoside A, active compound in bacopa, has
been shown to have biofilm disruption activity in vitro. 31
Banderol (Otoba parvifolia) and Antibacterial activity with Borrelia, antiprotozoal
Cat’s claw (Uncaria tomentosa) activity with Babesia species. Herbs used in combination
have synergistic action with increased ability to kill
Borrelia burgdorferi by 90 percent and biofilm
production. 32
REFERENCE CHARTS 225

ANTIMICROBIAL HERBS (continued)
HERBS BENEFITS
Berberine-containing herbs, Coptis can work synergistically enhancing antibiotic action,
Goldenseal, Oregon grape root, decreasing bacterial adhesion and invasion. 33 Goldenseal
Coptis chinensis, Barberry root inhibits efflux pump action in biofilm. 34 Berberine com-
pounds are “natural antibiotic.”35 Antiviral and antifungal
Black walnut A very commonly used, very bitter anti-parasitic. Works
topically with fungal skin infections. 36 Enhances
tetracycline and erythromycin37
Blue flag iris A remedy historically used for other spirochetal
infections such as syphilis and is also a blood purifier,
making it helpful with Bartonella/Babesia infections
Clove (Syzygium aromaticum) Antibacterial, antifungal, and antiviral activity,
analgesic when used topically for tooth pain. Is used
both as essential oil and tincture38
Grapefruit seed extract Antimicrobial action with spirochetes, biofilm, and cyst
form of Borrelia burgdorferi39
Houttuynia Immune modulator, antiviral, antibacterial, and reduced
symptoms associated with allergy. Most frequently used
with Bartonella infection
Japanese knotweed Antibacterial, anti-inflammatory, anti-hyperlipidemic.40
Provides a promising antimicrobial agent against
drug-resistant bacteria41
Lomatium dissectum Antiviral,42 expectorant, immune stimulant
Mullein Anti-inflammatory, antiviral, antifungal, antibacterial,
antitumor, expectorant.43 Disrupts bacterial membranes44
Nettles Anti-inflammatory, antiseptic, detoxifier, vasodilator,
and antirheumatic. Decreases biofilm formation when
used with antibiotics45
Nyctanthes arbor-tristis Linn. Ayurvedic herb used as an anti-malarial medication most
indicated for Babesia species46
Red root (Ceanothus) Effective with pathogens found in the oral cavity such as
Streptococcus.47 Supports lymphatic drainage and healing
for the spleen48
Skullcap (Scutellaria Anti-influenza remedy (H1N1),49 antibacterial and
baicalensis) antifungal activities50
Stephania root It is able work with dopamine receptors to improve
psychomotor dysfunction and mood stabilization. 51 It
downregulates the genes that express joint invading
proteins. 52 Effective in treating herpes simplex viral
types I and II53
Teasel (Dipsacus sylvestris) Antimicrobial effects tested to be effective with Borrelia
burgdorferi. Worked best with spirochete form 54
Medium-Chain Triglycerides Cryptolepis sanguinlenta: Anti-malarial activity.
(Cryptolepis sanguinolenta, Aqueous extract found to be effective treating malaria,
Sida acuta) especially with chloroquine-resistant forms; more rapid
fever reduction.55 Improved liver function and reducing
infections of red blood cells56
Sida acuta: Anti-malarial activity attributed to the
active compound cryptoleptine. 57 Best for Babesia
species. Liver protective, reducing changes in tissue with
chemical stressors58
BIOFILM-INHIBITING HERBS AND NUTRIENTS
Armoracia rusticana Biofilm buster for gram-negative bacteria 59
(Horseradish root)
Bioflavonoids: coumarin, Inhibited biofilm formation, inhibited bacterial motility60
quercetin, rutin, genistein, Quercetin dosing: 250–500 mg three to four times per day
rosmarinic acid
Garlic and allicin compounds Best administered in broth or liquid form for more
bacteriostatic impact and destruction of biofilm, whereas
the alcohol-based tincture has a more inhibitory action on
the formation itself.61
Hypericum species Antimicrobial and disabling biofilm production62
Panax ginseng Can reduce quorum sensing, inhibit biofilm and virulence
factors. Dosing amount is important depending on the bacter-
ium being treated, ideally a 0.5 percent aqueous solution.63 64
Scutellaria and monolaurin Synergistic effects in combination at breaking down and
increase permeability of biofilms colonies of several
pathogens especially Borrelia garinii and other Borrelia
species.65 Supports mitochondrial function
Stevia Whole-leaf extract used in culture medium showed
antimicrobial effects with Borrelia species. Was shown to
break down the extracellular polymeric substances,
reducing its ability to adhere to substances in vitro66
ADRENAL-SUPPORTIVE HERBS AND NUTRIENTS

Ashwagandha Supports proper cortisol release, enhancing energy,
(Withania somnifera) helpful in children or those with prolonged illness with
improved memory and focus, antianxiety properties equal
to that of lorazepam, reduced pain, and enhances
mitochondrial function67
Cordyceps 500–3,000 mg with food. Active ingredient cordycepin
has shown antimicrobial activity, improved libido,
cardiovascular support, increased cellular energy,
immune modulation.68 Supports mitochondrial function69
Dehydroepiandrosterone 10–50 mg per day. Important to have medically managed
(DHEA) with blood levels or salivary hormone levels monitored.
This can increase testosterone levels in both men and
women to unhealthy levels with excessive dosing. This
can improve energy, stamina, libido, and cognition.
Holy basil aka tulsi This is the herb that has multiple uses. Adaptogenic herb,
(Ocimum sanctum) assisting the nervous system, detox pathways, anti-in-
flammation, antimicrobial. Drinking the tea can be seen
as a form of “liquid yoga” due to its ability to calm the
nerves. It’s revered in many cultures as the goddess in
which every part of the plant is considered sacred.70
Licorice root Glycyrrhetic acid resembles structure of hormones
secreted by the adrenal cortex; accounts for the mineralo-
corticoid and glucocorticoid effects.71
Vitamin B6 Increases progesterone and natural corticosteroids in
animal models72

NATURAL ANTI-INFLAMMATORIES FOR BRAIN AND BODY
ANTI-INFLAMMATORIES DOSING/BENEFITS
Bacopa Antioxidant neuroprotection (via redox and enzyme
induction), acetylcholinesterase inhibition and/or
choline acetyltransferase activation, `-amyloid
reduction, increased cerebral blood flow, and neu-
rotransmitter modulation.73 Hepatoprotective.74
200–600 mg per day in capsules from dried herb.
Extract in ethyl alcohol (ETOH) 1:2 ratio 10–30 drops
per day. Can start at lower dose and gradually increase
Black cumin seed oil This has many benefits including pain management,
(Nigella sativa) antibacterial, antifungal, antiparasitic. It has been
shown to work in synergy with alpha lipoic acid,
L-carnitine to improve blood sugar levels.75
Borage oil/black currant oil 200–400 mg of gamma linolenic acid, which is the
anti-inflammatory fatty acid
Boswellia serrata 800–1,800 mg three times per day with or without food
California poppy Another berberine-rich compound that is neuroprotec-
tive, anti-inflammatory, and protects the inner lining of
the vascular system76
Fish oil 1,000–4,000 mg EPA/DHA combined. Effective
alternative to ibuprofen use for anti-inflammation.77
Can reduce inflammation in the brain with balancing
microglial response78
5-HTP/L-tryptophan Improve mood and enhancing serotonin in the brain.
Coadministration with creatinine can help improve
selective serotonin reuptake inhibitor (SSRI)–resistant
depression.79 When there is disruption of the microbiota
or inflammation of the bowel, there is disruption in the
balance of serotonin levels in the aspects of the brain
dictating mood, metabolism, pain, and cognition. Do not
take if using SSRI medications.
Forskolin (Coleus forskohlii) 180–400 mg with at least 10 percent forskolin, two to
four capsules per day. Beneficial for Lyme arthritis 80
Gamma-aminobutyric acid The supplementation of GABA has been conflicting in
(GABA) the research with the ability to cross the blood-brain
barrier, but with concomitant dosing with L-arginine, it
did show increased ability to do so. Increasing Lactoba-
cillus and Bifidobacterium increased GABA through the
enteric nervous system, as well as vagus nerve stimula-
tion.81 Oral dosage: 250–750 mg twice per day
German chamomile Reduced anxiety, depression and improved insomnia.
Improves the communication between brain and the
adrenal glands82
Gingerroot Antioxidant, anti-inflammatory, anti-nausea. Helps with
detoxification, inhibits pro-inflammatory cytokines83
Gotu kola (Centella asiatica) 750–1,000 mg per day improves cognition, reduces
oxidative stress in the brain, neuroplasticity within the
amygdala (area of the brain involved in emotional
experience), improves learning and memory. 84
NATU R AL ANTI - I N FL AM MATORI E S (continued)
Gou teng Inhibited neuronal cell death, reduced oxidative damage,
(Uncaria rhynchophylla) and increase glutathione.85 Reduction of amyloid plaques
in the brain related to degeneration seen in Alzhei-
mer’s.86 Reduction of anxiety due to enhanced serotonin
levels.87 Cardiovascular vasodilation effects supporting
healthy blood pressure.88 Attention deficit hyperactivity
disorder support.89 Most readily used in aqueous or
ETOH solution with daily 250–1,000 mg/kg dosing
Kava kava Kavalactones, active ingredient, improved depression.
(Piper methysticum) Analgesic and anesthetic using non-opioid pathways.90 It
can cause rash but is rare. Can enhance the effects of
alprazolam (Xanax). 50–70 mg three times daily
Lavender The essential oil has antibacterial, antifungal, and
(Lavandula angustifolia) mood-enhancing qualities. Sleep promoter. Aromather-
apy and topical use shown to decrease postpartum
depression.91 Inhalation showed enhancement of
function in several areas of the brain in women with
magnetic resonance imaging, positron-emission
tomography scans, increased alpha and theta waves in
the brain promoting calm, thus enhancing cognition.
Was shown to improve post-traumatic stress disorder–
related symptoms with oral dosing for six weeks of 80
mg.92 Oral dosing: 80–160 mg per day (proper dilution
within supplement intended for oral use; do not take
essential oil alone)
Light Most of us know this, but a reminder never hurts.
Increases serotonin levels, so the goal is to get outside
more. You need only thirty minutes on sunny day
(around 10,000 lux) or more time on cloudy day. Can buy
bulbs with different values (3,000–10,000 lux). Timing
of treatment is dependent on the strength of light. Also
reduction of light with blackout shades in bedrooms and
no screen time one to two hours before bed will enhance
natural melatonin production from the pineal gland.
Lion’s mane Protects the brain from neurotoxicity by enhancing
(Hericium erinaceus) mitochondrial function in nerve cells93
L-theanine 50–200 mg one to two times per day. Enhances alpha
brain waves supporting relaxation.94 Can reduce stress
by reducing sympathetic nervous excitation95
Magnolia officinalis and Dosing magnolol at 5–25 g/kg Improved REM sleep.96
Phellodendron amurense Anxiety-reducing qualities in menopausal women; active
ingredient honokiol and berberine.97 Improve cognition
by modification of the neurotransmitters, useful in
treating mild to moderate anxiety. Improved adrenal
function, improving mental acuity.98 Magnolia alone was
studied and found to have anti-biofilm properties with
common bacteria causing dental caries; active ingredient
is magnolol.99
Malic acid 1,200–3,000 mg dosing, paired with magnesium for
added benefit. For symptoms associated with fibromyal-
gia and chronic fatigue

Mapalo (Matapalo Dosing recommended at 10–30 drops one to two times
[Phoradendrum crassifolium]) per day added to water. The data on this revolve around
the plant species, the Ficus thonningii tree, which is
related to Mapalo showing antimicrobial activity as well
as neuroprotective.100
Melatonin 1–9 mg before bed. Improves sleep quality, increases
sleep time, and decreases time it takes to fall asleep.101
Improved sleep to decrease oxidation of brain tissue;
impaired mitochondrial function and neurodegenerative
inflammation102
Oat (Avena sativa) Improved attention and focus, task completion.103 Dosing
recommended at 1,600 mg
Panax ginseng 200–400 mg dosing. Neuronal anti-inflammatory,
reduces premature death of neurons, improved blood
flow to the brain with improved vascular support
Pancreatic enzymes One to three capsules twice daily. It’s hard to be concrete
with enzyme doses because of the use of different units of
measurement. Away from foods. Reduced inflammation
in the digestive tract, as foods are more appropriately
broken down, thus reducing systemic inflammation
Phosphatidylcholine Doses range from 300–4,000 mg. Please speak with
health professional to find appropriate dosing for your
body. This rebuilds myelin and cellular membranes.
Phosphatidylserine 100 mg three times per day. Required for healthy myelin
and cellular membranes104
Pyrroloquinoline quinone Increased blood flow to the brain with prevention of
(PQQ) age-related changes in attention and memory.105 Reduces
neurotoxicity and neuroinflamation 106
Resveratrol One to two 500 mg capsules daily. Can reduce oxidative
(Polygonum cuspidatum) damage of the brain in combination with curcumin107
Rhodiola rosea Improves neuronal repair by enhancing stem cells in the
hippocampus, decreases anxiety, improved cognition,
enhances serotonin and inhibits monoamine oxidase.108
Dose 100–1,200 mg/day (3 percent rosavin, 1 percent
salidroside)
Rosemary Inhibit neuronal cell death, reduction of heavy metals
(Rosmarinus officinalis) and reduction of brain inflammation in Alzheimer’s.109
Essential oil is antibacterial, antifungal, activity against
drug-resistant gram-positive bacteria, Candida albi-
cans.110 Tea: 1–2 g per day steeped in boiling water.
Essential oil: 0.1–1 ml (6–10 percent concentration)
massaged into scalp daily or 5 mg/kg. Extract: 2–4 ml
(1:1) 45 percent ETOH three times daily.
Saffron (Crocus sativum) Doses showed best outcome above 30 mg/day. Many
products commonly having approximately 80–90 mg per
capsule. Neuroprotective activity increasing glutathione
levels in brain, improving health of myelin sheath.111
Enhanced mood and decreased anxiety112
SAMe Dosing of 600 mg of enteric-coated tablets twice per day.
(S-adenosyl-L-methionine) Anti-inflammatory effects equal to COX-2 inhibitors
with pain after one month of administration.113
Sarsaparilla (Smilax) Pain reliever, antioxidant,114 anti-inflammatory
Schisandra berry Reduces inflammatory markers stimulating microglial
(Schisandra chinensis) response.115 Improved cognition116
Serrapeptase One capsule one to three times daily away from food.
Enzyme which can cross through the digestive lining to
have anti-inflammatory effects reducing pain in the
musculoskeletal system as well as biofilm-busting effects
St. John’s Wort Enhances GABA, serotonin levels. Please check with a
pharmacist or doctor before taking with other prescrip-
tion medications due to interactions.
Tianma Neuroprotective effects by modulating serine, improve
(Gastrodia elata Blume) neurosynaptic plasticity, decrease abnormal body
tremor or seizure-like activity especially when used
synergistically with Uncaria rhynchophylla. 117 118 1–1.5 g
powdered form
Turmeric/curcumin 400–600mg up to three times per day. Can cross blood-
brain barrier to reduce microglial pro-inflammatory
pathways119
Yarrow Two to four times per day dosing tincture at 30–40 drops
(Achillea millefolium) in two to four ounces (60–120 ml) of water. In tincture
form, anti-inflammatory action, can inhibit breakdown
of extracellular tissue over time,120 and hepatoprotec-
tive.121 Improves symptoms associated with autoimmune
encephalomyelitis in mice study due to decreasing
pro-inflammatory cells to cerebrum.122 As a flower
essence, it’s used for energy protection from electromag-
netic wave sensitivities with electronic devices.
Zhi Zi Reduce waking episodes at night.123 Essential oil has
(Gardenia jasminoides) antidepressant activity. Anti-inflammatory effect.124
Liver protective125

ESSENTIAL OILS WITH ANTIMICROBIAL PROPERTIES
This list summarizes benefits attributed to each oil but does not include all the possible
benefits. The oils in bold italic type show effective antimicrobial activity against
Borrelia burgdorferi and biofilm in peer-reviewed research.
ESSENTIAL OILS BENEFITS

Basil Pain relief, digestive support, debilitating fatigue
Bergamot Fevers, superficial wounds, depression, crisis, and fear
Chamomile, German Pain relief, female complaints, indigestion, nerve pain
Chamomile, Roman Infected skin, sunburns, insect bites, mood imbalance
Cinnamon Infections, pain relief, supports the healing of sexual trauma,
body image issues
Clove Toothaches, pain relief, digestive support, healthy boundaries,
childhood trauma, codependency. Improved cognition126
Eucalyptus globulus Respiratory support, pain, urinary complaints, helps heal feelings
of being undeserving
Frankincense Coughs, nervous asthma. Scars. Mental fatigue. Reducing
overwhelm. Enhances meditation. Father energy
ESSENTIAL OILS BENEFITS
Geranium Female hormone imbalance. Leaky gut. Grief and emotional crisis
Lavender Inflammation. Insomnia. Migraine. Anxiety. Helps one communi-
cate feelings to others
Lemon Lack of appetite, digestive imbalance. Clarity of thought, elevation
of mood, reducing critical thoughts
Lemongrass Muscle pain, ligaments and tendons. Indigestion. Detoxification.
Letting go of limiting beliefs
Magnolia Abdominal pain. Muscle pain. Difficulty with communication
and fears
Melissa Insomnia, stress, anxiety, nervousness
Myrrh Fungal skin infections, cough, insect bites. Mother energy and
helping one feel safe in the world
Orange Nervous anxiety. Weakness in legs. Detoxification
Oregano Antimicrobial effect with B. burgdorferi, reducing muscle
pain. Reduces blocks associated with needing to be right.
Unbalanced willpower
Peppermint Headaches. Inflammation of the bowels. Respiratory infections.
Depression, lack of joy, pessimism
Rosemary Arthritis complaints. Headaches. Fluid retention. Improved
cognition. Revival of vital fire
Sage Effective for gram-negative and gram-positive bacteria
Tea tree oil Viral and fungal skin infections. Wound healing
Vetive Muscle tension. PMS. Overworked. Grounding in crisis. Reveals
buried emotions
Yarrow Antibacterial and antifungal properties in the essential oil
compound (topical use only)127 128
REFERENCES
CHAPTER 1
1 Daniel E. Sonenshine and Kevin R. Macaluso, “Microbial Invasion vs. Tick Immune
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no. 7 (2015): 631–39.
3 W. Rueben Kaufman, S. Kaufman, and Peter C. Flynn, “Cuticle Expansion during
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CHAPTER 2
1 Katharine S. Walter, Giovanna Carpi, Adalgisa Caccone, and Maria A. Diuk-Wasser,
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Early Stage of Mammalian Infection,” Infection and Immunity 74, no. 6 (2006):
3554–64.
6 Alexia A. Belperron and Linda K. Bockenstedt, “Natural Antibody Affects Survival of
the Spirochete Borrelia burgdorferi within Feeding Ticks,” Infection and Immunity 69,
no. 10 (2001): 6456–62.
7 William T. Golde et al., “Culture-Confirmed Reinfection of a Person with Different
Strains of Borrelia burgdorferi Sensu Stricto,” Journal of Clinical Microbiology 36, no.
4, (1998):1015–19.
8 Tammi L. Johnson et al., “Isolation of the Lyme Disease Spirochete Borrelia mayonii
from Naturally Infected Rodents in Minnesota,” Journal of Medical Entomology 54, no.
4 (2017): 1088–92.
9 Centers for Disease Control and Prevention, CDC Newsroom, “New Lyme-Disease-
Causing Bacteria Species Discovered: Borellia mayonii Closely Related to B. burgdor-
feri,” Press Release, February 8, 2016, www.cdc.gov/media/releases/2016/p0208-
lyme-disease.html.
233
10 Centers for Disease Control and Prevention, CDC Newsroom, “New Lyme-Disease-
Causing Bacteria Species Discovered: Borellia mayonii Closely Related to B. burgdor-
feri,” Press Release, February 8, 2016, www.cdc.gov/media/releases/2016/p0208-
lyme-disease.html.
11 Daniel López, Hera Vlamakis, and Roberto Kolter, “Biofilms,” Cold Spring Harbor
Perspectives in Biology 2, no. 7 (2010): a000398.
12 Thomas Bjarnsholt, “The Role of Bacterial Biofilms in Chronic Infections,” Journal of
Pathology, Microbiology, and Immunology 121 (2013): 1–58.
13 Arunava Kali et al., “Antibacterial Synergy of Curcumin with Antibiotics against
Biofilm Producing Clinical Bacterial Isolates,” Journal of Basic and Clinical Pharmacy 7,
no. 3 (2016): 93–96.
14 Jingjing Sun, Ziqing Deng, and Aixin Yan, “Bacterial Multidrug Efflux Pumps:
Mechanisms, Physiology, and Pharmacological Exploitations,” Biochemical and
Biophysical Research 453, no. 2 (2014): 254–67.
15 Eva Sapi et al., “Characterization of Biofilm Formation by Borrelia burgdorferi In
Vitro,” PLoS ONE 7. no. 10 (2012): e48277, https://doi.org/10.1371/journal.pone.0048277.
16 Daniel J. Cameron, Lorraine B. Johnson, and Elizabeth L. Maloney, “Evidence
Assessments and Guideline Recommendations in Lyme Disease: The Clinical Manage-
ment of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease,” Expert
Review of Anti-infective Therapy 12, no. 9 (2014): 1103–35.
17 Michael J. Cook, “Lyme Borreliosis: A Review of Data on Transmission Time after
Tick Attachment,” International Journal of General Medicine 8 (2015): 1–8.
18 Gregory Bach, “Recovery of Lyme Spirochetes by PCR in Semen Samples of
Previously Diagnosed Lyme Disease Patients,” International Scientific Conference on
Lyme Disease, April 2001, www.anapsid.org/lyme/bach.html.
19 C.L. Williams et al., “Maternal Lyme Disease and Congenital Malformations: A Cord
Blood Serosurvey in Endemic and Control Areas,” Pediatric and Perinatal Epidemiol-
ogy 9, no. 3 (1995): 320-30.
20 Malgorzata Bednarska et al., “Vertical Transmission of Babesia microti in BALB/c
Mice: Preliminary Report,” PLoS ONE 10, no. 9 (2015): e0137731; Katarzyna Tolkacz et
al., “Prevalence, Genetic Identity and Vertical Transmission of Babesia microti in Three
Naturally Infected Species of Vole, Microtus Spp. (Cricetidae),” Parasites & Vectors 10
(2017): 66.
21 Kim B. Madsen et al., “Seroprevalence against Rickettsia and Borrelia Species in
Patients with Uveitis: A Prospective Survey,” Journal of Ophthalmology (2017):
9247465.
22 Geeta Ramesh et al., “The Lyme Disease Spirochete Borrelia burgdorferi Induces
Inflammation and Apoptosis in Cells from Dorsal Root Ganglia,” Journal of Neuroin-
flammation 10, no. 88 (2013): 1–14.
23 Thomas Gregor Issac et al., “Autonomic Dysfunction: A Comparative Study of
Patients with Alzheimer’s and Frontotemporal Dementia—A Pilot Study,” Journal of
Neurosciences in Rural Practice 8, no. 1 (2017): 84–88.
24 Robert B. Lochhead et al., “MicroRNA Expression Shows Inflammatory Dysregula-
tion and Tumor-Like Proliferative Responses in Joints of Patients with Postinfectious
Lyme Arthritis,” Arthritis and Rheumatology 69, no. 5 (2017): 1100–10.
25 Biju Vasudevan and Manas Chatterjee, “Lyme Borreliosis and Skin,” Indian Journal
of Dermatology 58, no. 3 (2013): 167–74.
26 Kurt E. Müller, “Damage of Collagen and Elastic Fibres by Borrelia burgdorferi—
Known and New Clinical and Histopathological Aspects,” The Open Neurology
Journal 6 (2012): 179–86.
CHAPTER 3
1 TickReport. “Tick-borne Diseases Passive Surveillance Database,” 2018,
www.tickreport.com/stats.
2 Udoka Okaro et al., “Bartonella Species, an Emerging Cause of Blood-Culture-
Negative Endocarditis,” Clinical Microbiology Reviews 30, no. 3 (2017): 709–46.
3 MicrobeWiki, “Bartonella henselae,” Microbial Biorealm page on the genus Barton-
ella henselae, last edited 2010, https://microbewiki.kenyon.edu/index.php/
Bartonella_henselae.
4 James L. Schaller, Glenn A. Burkland, and P. J. Langhoff, “Do Bartonella Infections
Cause Agitation, Panic Disorder, and Treatment-Resistant Depression?” Medscape
General Medicine 9, no. 3 (2007): 54.
5 Ricardo G. Maggi et al., “Bartonella Spp. Bacteremia and Rheumatic Symptoms in
Patients from Lyme Disease–Endemic Region,” Emerging Infectious Diseases 18, no. 5
(2012): 783–91.
6 Nahed Ismail, Karen C. Bloch, and Jere W. McBride, “Human Ehrlichiosis and
Anaplasmosis,” Clinics in Laboratory Medicine 30, no. 1 (2010): 261–92.
7 Jennifer H. McQuiton et al., “Inadequacy of IgM Antibody Tests for Diagnosis of
Rocky Mountain Spotted Fever,” The American Journal of Tropical Medicine and
Hygiene 91, no. 4 (2014): 767–70.
8 Jessica Snowden and Kari A. Simonsen, “Tick, Rickettsia Rickettsiae (Rocky
Mountain Spotted Fever),” StatPearls [Internet], 2017, https://www.ncbi.nlm.nih.gov/
books/NBK430881/.
9 Eliane Esteves et al., “Analysis of the Salivary Gland Transcriptome of Unfed and
Partially Fed Amblyomma sculptum Ticks and Descriptive Proteome of the Saliva,”
Frontiers in Cellular and Infection Microbiology 7 (2017): 476, doi:10.3389/
fcimb.2017.00476.
10 Carole Eldin et al., “From Q Fever to Coxiella burnetii Infection: A Paradigm
Change,” Clinical Microbiology Reviews 30, no. 1 (2017): 115–90. doi: 10.1128/
CMR.00045-16.
11 Carole Eldin et al., “From Q Fever to Coxiella burnetii Infection: A Paradigm
Change,” Clinical Microbiology Reviews 30, no. 1 (2017): 115–90. doi: 10.1128/
CMR.00045-16.
12 Fabiola Mancini et al., “Prevalance of Tick-Borne Pathogens in an Urban Park in
Rome, Italy,” Annals of Agricultural and Environmental Medicine 21, no. 4 (2014):
723–27.
13 Gilbert J. Kersh, “Antimicrobial Therapies for Q Fever,” Expert Review of Anti-
infective Therapy 11, no. 11 (2013): 1207–14.
14 Ludovic Pilloux et al., “The High Prevalence and Diversity of Chlamydiales DNA
within Ixodes ricinus Ticks Suggest a Role for Ticks as Reservoirs and Vectors of
Chlamydia-Related Bacteria,” ed. H. L. Drake, Applied and Environmental Microbiology
81, no. 23 (2015): 8177–82.
15 Eugene Escrow et al., “Evidence for Disseminated Mycoplasma fermentans in New
Jersey Residents with Antecedent Tick Attachment and Subsequent Musculoskeletal
Symptoms,” Journal of Clinical Rheumatology 9, no. 2 (2003): 77–87.
16 A.S. Ramirez et al., “Relationship between Rheumatoid Arthritis and Mycoplasma
pneumoniae: A Case–Control Study,” Rheumatology 44, no. 7 (2005): 912–14.
17 Sevgi Yimenicioglu et al., “Mycoplasma pneumoniae Infection with Neurologic
Complications,” Iranian Journal of Pediatrics 24, no. 5 (2014): 647–51.
18 H.O. Kangro et al., “A Prospective Study of Viral and Mycoplasma Infections in
Chronic Inflammatory Bowel Disease,” Gastroenterology 98 (1990): 549–53.
19 Wangxue Chen et al., “High Prevalence of Mycoplasma pneumoniae in Intestinal
Mucosal Biopsies from Patients with Inflammatory Bowel Disease and Controls,”
Digestive Diseases and Sciences 46, no. 11 (2001): 2529–35.
20 C.C. Kuo et al., “Chlamydia pneumoniae (TWAR),” Clinical Microbiology Reviews 8,
no. 4 (1995): 451–61.
21 Andrea S. Varela-Stokes et al., “Microbial Communities in North American Ixodid
Ticks of Veterinary and Medical Importance,” Frontiers in Veterinary Science 4 (2017):
179.
22 Patrick Forterre, “Defining Life: The Virus Viewpoint,” Origins of Life and Evolution
of the Biosphere 40, no. 2 (2010): 151–60.
23 Meghan E. Hermance and Saravanan Thangamani, “Tick Saliva Enhances Powassan
Virus Transmission to the Host, Influencing Its Dissemination and the Course of
Disease,” Journal of Virology 89, no. 15 (2015): 7852–60.
24 Syed Soheb Fatmi, Rija Zehra, and David O. Carpenter, “Powassan Virus—A New
Reemerging Tick-Borne Disease,” Frontiers in Public Health 5 (2017): 342; E.R.
Campagnolo et al., “Evidence of Powassan/Deer Tick Virus in Adult Blacklegged Ticks
(Ixodes scapularis) Recovered from Hunter-Harvested White-Tailed Deer (Odocoileus
virginianus) in Pennsylvania: A Public Health Perspective,” Zoonoses and Public Health
65, no. 5 (2018): 589–94.
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25 Tibor Füzik et al., “Structure of Tick-Borne Encephalitis Virus and Its Neutralization
by a Monoclonal Antibody,” Nature Communications 9 (2018): 436.
26 Dace Zavadska et al., “Recommendations for Tick-Borne Encephalitis Vaccination
from the Central European Vaccination Awareness Group (CEVAG),” Human Vaccines
& Immunotherapeutics 9, no. 2 (2013): 362–74.
27 Wolfgang Hammerschmidt and Bill Sugden, “Replication of Epstein-Barr Viral
DNA,” Cold Spring Harbor Perspectives in Biology 51 (2013): a013029.
28 Kate T. Brizzi and Jennifer L. Lyons, “Peripheral Nervous System Manifestations of
Infectious Diseases,” ed. Jennifer Lyons, The Neurohospitalist 4, no. 4 (2014): 230–40.
29 E. Alari-Pahissa et al., “Low Cytomegalovirus Seroprevalence in Early Multiple
Sclerosis: A Case for the ‘Hygiene Hypothesis’?” European Journal of Neurology 25,
no. 7 (2018): 925-33.
30 Richard J. Whitley, “Herpesviruses,” in Medical Microbiology, 4th ed., ed.
Samuel Baron (Galveston: University of Texas Medical Branch at Galveston, 1996),
www.ncbi.nlm.nih.gov/books/NBK8157/.
31 Larry J. Strausbaugh et al., “Human Herpesvirus 6,” Clinical Infectious Diseases 33,
no. 6 (2001): 829–33.
32 John B. Harley et al., “Transcription Factors Operate across Disease Loci, with
EBNA2 Implicated in Autoimmunity,” Nature Genetics 50 (2018): 699–707.
33 Kate T. Brizzi and Jennifer L. Lyons, “Peripheral Nervous System Manifestations of
Infectious Diseases,” ed. Jennifer Lyons, The Neurohospitalist 4, no. 4 (2014): 230–40.
34 Jeffrey I. Cohen et al., “Characterization and Treatment of Chronic Active
Epstein-Barr Virus Disease: A 28-Year Experience in the United States,” Blood 117,
no. 22 (2011): 5835–49.
35 Jürgen Schulze and Ulrich Sonnenborn, “Yeasts in the Gut: From Commensals to
Infectious Agents,” Deutsches Ärzteblatt International 106, no. 51–52 (2009): 837–42;
Franziska Gerwien et al., “The Fungal Pathogen Candida glabrata Does Not Depend
on Surface Ferric Reductases for Iron Acquisition,” Frontiers in Microbiology 8 (2017):
1055.
36 Mary J. Homer et al., “Babesiosis,” Clinical Microbiology Reviews 13, no. 3 (2000):
451–69.
37 Robert E. Quick, “Babesiosis in Washington State: A New Species of Babesia?”
Annals of Internal Medicine 119, no. 4 (1993): 284–90.
38 FDA News Release, “FDA Approves First Tests to Screen for Tick-Borne Parasite in
Whole Blood and Plasma to Protect the U.S. Blood Supply,” Press Release, March 6,
2018, www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm599782.htm.
39 I. J. Udeinya et al., “An Antimalarial Extract from Neem Leaves Is Antiretroviral,”
Transactions of the Royal Society of Travel Medicine & Hygiene 98, no. 7 (2004): 435-37.
40 Chhaya S. Godse et al., “Antiparasitic and Disease-Modifying Activity of Nyctan-
thes arbor-tristis Linn. in Malaria: An Exploratory Clinical Study,” Journal of Ayurveda
and Integrative Medicine 7, no. 4 (2016): 238–48.
CHAPTER 4
1 Alexis Lacout et al., “Biofilms Busters to Improve the Detection of Borrelia Using
PCR,” Medical Hypothesis 112 (2018): 4–6.
2 Raphael B. Stricker and Edward E. Winger, “Decreased CD57 Lymphocyte Subset in
Patients with Chronic Lyme Disease,” Immunology Letters 76, no. 1 (2001): 43–48.
3 Raphael B. Stricker and Edward E. Winger, “Decreased CD57 Lymphocyte Subset in
Patients with Chronic Lyme Disease,” Immunology Letters 76, no. 1 (2001): 43–48.
4 Uday C. Ghoshal, Ratnakar Shukla, and Ujjala Ghoshal, “Small Intestinal Bacterial
Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic
Dichotomy,” Gut and Liver 11, no. 2 (2017): 196–208.
CHAPTER 5
1 John N. Aucott, “Development of a Foundation for a Case Definition of Post-treatment
Lyme Disease Syndrome,” International Journal of Infectious Diseases 17 (2013):
e443–e449.
2 Monica E. Embers et al., “Variable Manifestations, Diverse Seroreactivity and
Post-treatment Persistence in Non-Human Primates Exposed to Borrelia burgdorferi
by Tick Feeding,” PLoS ONE 12, no. 12 (2017): e0189071.
3 Gary P. Wormser et al., “The Clinical Assessment, Treatment, and Prevention of
Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice
Guidelines by the Infectious Diseases Society of America,” Clinical Infectious Diseases
43, no. 9 (2006): 1089–1134.
4 Daniel J. Cameron, Lorraine B. Johnson, and Elizabeth L. Maloney, “Evidence
Assessments and Guideline Recommendations in Lyme Disease: The Clinical Manage-
ment of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease,” Expert
Review of Anti-infective Therapy 12, no. 9 (2014): 1103–35.
CHAPTER 6
1 U.S. Food & Drug Administration, “Label Claims for Conventional Foods and Dietary
Supplements,” last updated June 19, 2018, www.fda.gov/Food/LabelingNutrition/
ucm111447.htm.
2 Lorraine Johnson et al., “Severity of Chronic Lyme Disease Compared to Other
Chronic Conditions: A Quality of Life Survey,” ed. Claus Wilke, PeerJ 2 (2014): e322.
CHAPTER 7
1 Institute of Medicine (U.S.) Food Forum, “Study of the Human Microbiome,”
The Human Microbiome, Diet, and Health: Workshop Summary 2 (2013),
2 Institute of Medicine (U.S.) Food Forum, “Study of the Human Microbiome,”
The Human Microbiome, Diet, and Health: Workshop Summary 2 (2013),
3 Leo Galland, “The Gut Microbiome and the Brain,” Journal of Medicinal Food 17,
no. 12 (2014): 1261–72.
4 Yu-Heng Mao et al., “Protective Effects of Natural and Partially Degraded Konjac
Glucomannan on Bifidobacteria against Antibiotic Damage,” Carbohydrate Polymers
181, no. 1 (2018): 368–75.
5 Francisco Guarner, “Prebiotics in Inflammatory Bowel Diseases,” British Journal of
Nutrition 98, no. S1 (2007): S85–S89.
6 Rima Hatoum, Steve Labrie, and Ismail Fliss, “Antimicrobial and Probiotic Properties
of Yeasts: From Fundamental to Novel Applications,” Frontiers in Microbiology 3
(2012): 421.
7 Jürgen Schulze and Ulrich Sonnenborn, “Yeasts in the Gut: From Commensals to
Infectious Agents,” Deutsches Ärzteblatt International 106, no. 51–52 (2009): 837–42.
8 Joan Hui Juan Lim et al., “Bimodal Influence of Vitamin D in Host Response to
Systemic Candida Infection—Vitamin D Does Matter,” The Journal of Infectious
Disease 212, no. 4 (2015): 635–44.
9 Pragati Rawat, Swatantra Agarwal, and Siddhi Tripathi, “Effect of Addition of
Antifungal Agents on Physical and Biological Properties of a Tissue Conditioner: An
In-Vitro Study,” Advanced Pharmaceutical Bulletin 7, no. 3 (2017): 485–90.
10 Soheil Moghadamtousi Zorofchian et al., “A Review on Antibacterial, Antiviral, and
Antifungal Activity of Curcumin,” BioMed Research International 2014 (2014), article
ID 186864, 12 pages.
11 Nils-Otto Ahnfelt and Hjalmar Fors, “Making Early Modern Medicine: Reproducing
Swedish Bitters,” Ambix 63, no. 2 (2016): 162–83, doi:10.1080/00026980.2016.1212886.
12 Michael K. McMullen, Julie M. Whitehouse, and Anthony Towell, “Bitters: Time for a
New Paradigm,” Evidence-Based Complementary and Alternative Medicine 2015
(2015), article ID 670504, 8 pages.
13 Robin DiPasquale, “Herbs as Bitters: It’s a Matter of Degree,” January 19, 2009,
http://ndnr.com/womens-health/herbs-as-bitters-its-a-matter-of-degree/.
14 Sarah E. Edwards et al., “Dandelion,” in Phytopharmacy: An Evidence-Based Guide
to Herbal Medicinal Products (Chichester, West Sussex [U.K.]: John Wiley & Sons,
2015), 129.
15 Joseph Pizzorno, “Glutathione!” Integrative Medicine: A Clinician’s Journal 13, no. 1
(2014): 8–12.
16 Ademola C. Famurewa et al., “Dietary Supplementation with Virgin Coconut Oil
Improves Lipid Profile and Hepatic Antioxidant Status and Has Potential Benefits on
Cardiovascular Risk Indices in Normal Rats,” Journal of Dietary Supplements 15, no. 3
(2018): 330–42.
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17 John W. Newcomer, Nuri B. Farber, and John W. Olney, “NMDA Receptor Function,
Memory, and Brain Aging,” Dialogues in Clinical Neuroscience 2, no. 3 (2000): 219–32.
18 Willmann Liang et al., “Current Evidence of Chinese Herbal Constituents with
Effectson NMDA Receptor Blockade,” Pharmaceuticals 6, no. 8 (2013): 1039–54.
CHAPTER 8
1 Mary Norval, “A Short Circular History of Vitamin D from Its Discovery to Its Effects,”
Res Medica 268, no. 2 (2005): 57–58.
2 Meg Mangin, Rebecca Sinha, and Kelly Fincher, “Inflammation and Vitamin D: The
Infection Connection,” Inflammation Research 63, no. 10 (2014): 803–19.
3 S.P Yenamandra et al., “Expression Profile of Nuclear Receptors upon Epstein-Barr
Virus Induced B Cell Transformation,” Experimental Oncology 31, no. 2 (2009): 92–96.
4 Yongzhong Xu et al., “Using a cDNA Microarray to Study Cellular Gene Expression
Altered by Mycobacterium tuberculosis,” Chinese Medical Journal 116, no.7 (2003):
1070–73. et al.,
5 Timothy E. Welty, Adrienne Luebke, and Barry E. Gidal, “Cannabidiol: Promise and
Pitfalls,” Epilepsy Currents 14, no. 5 (2014): 250–52.
6 Garth L. Nicolson, “Mitochondrial Dysfunction and Chronic Disease: Treatment with
Natural Supplements,” Integrative Medicine: A Clinician’s Journal 13, no. 4 (2014):
35–43.
7 Kari Johnson et al., “Use of Aromatherapy to Promote a Therapeutic Nurse
Environment,” Intensive and Critical Care Nursing 40 (2017): 18–25.
8 Jie Feng et al., “Selective Essential Oils from Spice or Culinary Herbs Have High
Activity against Stationary Phase and Biofilm Borrelia burgdorferi,” Frontiers in
Medicine 4 (2017): 169.
CHAPTER 9
1 Kurt E. Müller, “Damage of Collagen and Elastic Fibres by Borrelia burgdorferi—
Known and New Clinical and Histopathological Aspects,” The Open Neurology
Journal 6 (2012): 179–86.
2 Christopher D’Adamo et al., “Supervised Resistance Exercise for Patients with
Persistent Symptoms of Lyme Disease,” Medicine & Science in Sports & Exercise 47,
no. 11 (2015): 2291–98.
3 Roger Jahnke et al., “A Comprehensive Review of Health Benefits of Qigong and Tai
Chi,” American Journal of Health Promotion 24, no. 6 (2010): e1–e25.
4 Ju-Hyun Jeon et al., “A Feasibility Study of Moxibustion for Treating Anorexia and
Improving Quality of Life in Patients with Metastatic Cancer: A Randomized
Sham-Controlled Trial,” Integrative Cancer Therapies 16, no. 1 (2017): 118–25.
5 Sven Å Bood, Anette Kjellgren, and Torsten Norlander, “Treating Stress-Related Pain
with the Flotation Restricted Environmental Stimulation Technique: Are There
Differences between Women and Men?” Pain Research & Management: The Journal of
the Canadian Pain Society 14, no. 4 (2009): 293–98.
6 C. Michael Dunham, Jesse V. McClain, and Amanda Burger, “Comparison of
Bispectral Index™ Values during the Flotation Restricted Environmental Stimulation
Technique and Results for Stage I Sleep: A Prospective Pilot Investigation,” BMC
Research Notes 10 (2017): 640.
7 Bruno Bordoni et al., “Emission of Biophotons and Adjustable Sounds by the Fascial
System: Review and Reflections for Manual Therapy,” Journal of Evidence-Based
Integrative Medicine 23 (2018): 2515690X17750750.
8 Yuji Soejima et al., “Effects of Waon Therapy on Chronic Fatigue Syndrome: A Pilot
Study,” Internal Medicine 54 (2015): 333–38.
9 Lino Sergio Rocha Conceição et al., “Effect of Waon Therapy in Individuals with
Heart Failure: A Systematic Review,” Journal of Cardiac Failure 24, no. 3 (2018):
204–206.
10 Shanshan Shui et al., “Far-Infrared Therapy for Cardiovascular, Autoimmune, and
Other Chronic Health Problems: A Systematic Review,” Experimental Biology and
Medicine 240, no. 10 (2015): 1257–65.
CHAPTER 10
1 Robert C. Bransfield, “Suicide and Lyme and Associated Diseases,” Neuropsychiatric
Disease and Treatment 13 (2017): 1575–87.
2 Myrna M. Weissman et al., “Families at High and Low Risk for Depression: A
3-Generation Study,” Archives of General Psychiatry 62, no. 1 (2005): 29–36.
3 Rachel Yuhuda et al., “Holocaust Exposure Induced Intergeneration Effects on
FKBP5 Methylation,” Biological Psychiatry 80, no. 5 (2016): 372–80.
4 Carrie Deans and Keith A. Maggert, “What Do You Mean, ‘Epigenetic’?” Genetics
199, no. 4 (2015): 887–96.
5 Gwenn A. Garden, “Epigenetics and the Modulation of Neuroinflammation,”
Neurotherapeutics 10, no. 4 (2013): 782–88.
6 Robert C. Bransfield, “Aggressiveness, Violence, Homicidality, Homicide, and Lyme
Disease,” Neuropsychiatric Disease and Treatment 14 (2018): 693–713.
7 Emeran A. Mayer, “Gut Feelings: The Emerging Biology of Gut-Brain Communica-
tion,” Nature Reviews Neuroscience 12, no. 8 (2011): 453–66, doi:10.1038/nrn3071.
8 Stephen W. Porges, “Neuroception: A Subconscious System for Detecting Threats
and Safety,” Zero to Three (J) 24, no. 5 (2004): 19–24, http://se-foreningen.no/
wp-content/uploads/2016/09/neuroception.pdf.
9 Norman Farb et al., “Interoception, Contemplative Practice, and Health,” Frontiers in
Psychology 6 (2015): 763.
CHAPTER 11
1 Jennifer E. Stellar et al., “Positive Affect and Markers of Inflammation: Discrete
Positive Emotions Predict Lower Levels of Inflammatory Cytokines,” Emotion 15, no. 2
(2015): 129–33.
2 Seth Lloyd, “Quantum Coherence in Biological Systems,” Journal of Physics:
Conference Series 302 (2011): 1–5.
3 Richard Hammerschlag et al., “Biofield Physiology: A Framework for an Emerging
Discipline,” Global Advances in Health and Medicine 4 (2015): 35–41.
4 Fernando Sarmento et al., “Effectiveness of Biofield Therapy for Patients Diagnosed
with Fibromyalgia,” Alternative Therapies in Health and Medicine 23, no. 7 (2017): n.p.
5 Shamini Jain et al., “Clinical Studies of Biofield Therapies: Summary, Methodological
Challenges, and Recommendations,” Global Advances in Health and Medicine 4,
Supplement (2015): 58–66.
6 Eugene Rosenburg and Ilana Zilber-Rosenberg, “The Hologenome Concept of
Evolution after 10 Years,” Microbiome 6 (2018): 78.
7 Lynn Margulis, “Symbiogenesis and Symbionticism,” in Symbiosis as a Source of
Evolutionary Innovation: Speciation and Morphogenesis, ed. Lynn Margulis and René
Fester (Cambridge: MIT Press, 1991), 1–14.
8 Melike Demir Dogan, “The Effect of Reiki on Pain: A Meta-Analysis,” Complementary
Therapies in Clinical Practice 31 (2018): 384–87.
REFERENCE CHARTS
1 Yu-Heng Mao et al, “Protective Effects of Natural and Partially Degraded Konjac
Glucomannan on Bifidobacteria against Antibiotic Damage.” Carbohydrate Polymers
181 (2018): 368–75.
2 Jawad Behbehani et al., “The Natural Compound Magnolol Affects Growth, Biofilm
Formation, and Ultrastructure of Oral Candida Isolates,” Microbial Pathogenesis 133
(2017): 209–17.
3 Juanita Bustamante et al., “_-Lipoic Acid in Liver Metabolism and Disease,” Free
Radical Biology and Medicine 24, no. 6 (1998): 1023–39.
4 Xiaoyun Wei et al., “The Therapeutic Effect of Berberine in the Treatment of
Nonalcoholic Fatty Liver Disease: A Meta-Analysis,” Evidence-Based Complementary
and Alternative Medicine, 2016 (2016), article ID 3593951, 9 pages.
5 Attalla Farag El-Kott and Mashael Mohammed Bin-Meferij, “Use of Arctium lappa
Extract against Acetaminophen-Induced Hepatotoxicity in Rats,” Current Therapeutic
Research, Clinical and Experimental 77 (2015): 73–78.
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6 Sahar Y. Al-Okbi et al., “Hepatic Regeneration and Reno-Protection by Fish Oil,
Nigella sativa Oil and Combined Fish Oil/Nigella sativa Volatiles in CCl4 Treated Rats,”
Journal of Oleo Science 67, no. 3 (2018): 345–53.
7 Emine Colak et al., “The Hepatocurative Effects of Cynara scolymus L. Leaf Extract
on Carbon Tetrachloride-Induced Oxidative Stress and Hepatic Injury in Rats,”
SpringerPlus 5 (2016): 216.
8 Maryem Ben Salem et al., “Pharmacological Studies of Artichoke Leaf Extract and
Their Health Benefits,” Plant Foods for Human Nutrition 70 (2015): 441.
9 Maryem Ben Salem et al., “Protective Effects of Cynara scolymus Leaves Extract on
Metabolic Disorders and Oxidative Stress in Alloxan-Diabetic Rats,” BMC Complemen-
tary and Alternative Medicine 17 (2017): 328.
10 Ali Pezeshki et al., “The Effect of Green Tea Extract Supplementation on Liver
Enzymes in Patients with Nonalcoholic Fatty Liver Disease,” International Journal of
Preventive Medicine 7 (2016): 28.
11 A.G. Morgan and W.A. McAdam, “Glycyrrhiza glabra Monograph,” Alternative
Medicine Review 10, no. 3 (2005): 230–37.
12 Christopher Hobbs, Natural Therapy for Your Liver: Herbs and Other Natural
Remedies for a Healthy Liver, 2nd ed. (New York: Avery, 2002), 117.
13 Drugs.com, “Milk Thistle,” September 18, 2017, https://www.drugs.com/npp/
milk-thistle.html.
14 Ludovico Abenavoli et al., “Milk Thistle in Liver Diseases: Past, Present, Future,”
Phytotherapy Research 24 (2010): 1423–32.
15 Memorial Sloan Kettering Cancer Center, “Sho-saiko-to,” February 7, 2014,
www.mskcc.org/cancer-care/integrative-medicine/herbs/sho-saiko.
16 Dewasya Pratap Singh and Dayanandan Mani, “Protective Effect of Triphala
Rasayana against Paracetamol-Induced Hepato–Renal Toxicity in Mice,” Journal of
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Acknowledgments
This book was written with every spare hour or few minutes that were available on
a daily basis. It was written on planes, during halftime at my children’s soccer
games, between patients at my clinic, late nights, early mornings, and in the middle
of dinner running to my computer to get the words out before they disappeared.
Thank you to Steven Greenspan, my children, and my father, William Geil, for your
support in accomplishing my goal of experiencing the joy of manifesting a book.
I have such gratitude for the opportunity to work with The Quarto Group.
Special thanks to Amanda Waddell, Susan Lauzau, and David Umla for your
guidance through the process.
This book is also dedicated to every patient I have had the privilege to work
with, even if for a short while. Each and every encounter has been a learning
experience improving my practice of medicine.I have learned more from my
patients than I ever could from a book or lecture. I hope this book serves as a piece
of information to help you on your path of reclaiming your optimal health.
This book came about after being asked to participate as a guest lecturer with a
local chapter of the Holistic Mom’s Network. Thank you, Esther Roy, N.D., for the
invitation to be a speaker. I also have such gratitude for our time working together
and how well you managed my clinic when I was on maternity leave with my
second child.
My deepest gratitude to Destiny Green, N.D., who completed her year-long
residency in my clinic throughout the process of writing this book. She contributed
to research and data collection, which was invaluable. I look forward to our
continued collaboration in the daily workings of the clinic and excited to watch
you evolve as a doctor in the coming years. It’s a privilege to be a part of your
professional development.
Thank you to my friend and colleague Laura Chan, N.D., L.Ac., for your
support over the years. Your friendship and helpful feedback on the manuscript
over the course of the year were important for my morale when I needed another
set of eyes.
Thank you to my office staff, Michelle Darrow, Becky Stapleton, Kimmie King,
and Susan O’Leary.You have all supported me professionally and personally for
many years. This book was possible because of your friendship, loyalty, and
sisterhood. Thank you for making sure my needs were met through the process
and for having infinite patience with me as your boss. Each of you holds such an
important role in the inner workings of my medical practice, which allows me to
live my dream of being a doctor more fully than I could have imagined.
To my best friend, Arlene Hayes, for your unconditional friendship, honesty,
love, and emotional support, and for our daily drive conversations.
To Theresa Anderson, you have my deep gratitude for our friendship, your
support, for watching my kids when I need to make time to write, and for your
lightness of being in times I was overwhelmed.
To Joan Ruggiero, you hold a special place in my heart. Words are not enough
to convey my gratitude for your presence as a teacher in my life, your light, your
authentic style, and your devotion to the work is what I strive to emulate.Thank you.
To Ann Acheson, deepest gratitude for your wisdom, moral support, profound
healing abilities, how you carry yourself with such grace, and authenticity.You are
an amazing teacher in my life and I’m blessed to have your friendship.
I’m a better doctor and person for having these individual teachers in my life to
help me learn to blend science and spirit: Georgette Star; Sandra Ingerman, M.A.;
Leontine Hartzell; Dick Thom, D.D.S., N.D.; Guan-Cheng Sun, Ph.D.; Gene Ang,
Ph.D.; Miguel Ojeda-Rios, M.D.; Esther Mora, D.D., D.MT.; Heather Zwickey,
Ph.D.; Naomi Lewis, India Rose Waters, M.A.; Deborah Willimott, and many more,
as well as the teachers to come.
Special thanks to trailblazers in tick-borne disease who have helped me in so
many ways in the evolution of my medical specialty, Richard Horowitz, M.D.,
Charles Ray Jones, M.D., Joseph Burrascano, M.D.; Nevena Zubcevik, D.O.;
Dietrich Klinghardt, M.D., Ph. D.; Ritchie Shoemaker, M.D.; Robert Bransfield,
M.D.; Carrie Chojnowski, N.D.; and Leon Hecht, N.D. As well as many more.
Thank you to the International Lyme and Associated Diseases Society (ILADS) for
creating community to share ideas, clinical pearls, research, and improve the
quality of care for those suffering with tick-borne disease.
Other teachers whom have made an impact on my life through the written
word or online learning are Stanislav Grof, M.D.; Robert Gilbert, Ph.D.; Thomas
Hübl, Alton Kamadon, J.J Hurak, Ph.D.; Rudolph Steiner, Paramahansa Yoga-
nanda, and Swami Muktananda…as well as many more. My heart is so full.
About the Author

Julia Greenspan, N.D., runs the private medical practice Greenhouse Naturo-
pathic Medicine (www.greenhousemedicine.com) and has been treating patients
for tick-borne disease in New Hampshire—one of the epicenters for Lyme
disease—for more than 10 years. She is a member of the International Lyme and
Associated Disease Society (ILADS), the New Hampshire Association of Naturo-
pathic Doctors, and the American Association of Naturopathic Physicians. She has
been interviewed as an expert in Lyme disease on both radio and television and
has been published in the Naturopathic Doctor News and Review, the national
publication for Naturopathic Physicians.
Dr. Greenspan has a background in psychology and social work specializing
in crisis management, and uses a personalized, multi-faceted approach in the
treatment of Lyme and other diseases. She holds a Bachelor of Science in Psychol-
ogy from Portland State University in Oregon and is a graduate from the National
College of Natural Medicine. She is a patient advocate, Lyme disease survivor,
mother of two, energy healer, lecturer, beekeeper, lifelong student, and dark
chocolate addict.
247
INDEX
Abdominal pain, 51 used with other treatments, B. burgdorferi, 28, 29, 30, 31,
Acorn production, 20 26, 27 34, 37–38, 45, 55, 79, 88,
Acrodermatitis chronic vilified, 27 102, 147
atrophicans (ACA), 50 Antifungal nutrients, 224 Bell’s palsey, 35–36
Acupressure wristbands, 42 Anti-inflammatories, 47, 49–50. Beneficial yeast, 130–132
Acupuncture, 106, 158, 171 See also Natural Berberine, 34, 224, 226
Acute Lyme disease anti-inflammatories Bergamot, 161
becoming chronic Lyme Antimicrobial herbs, 140–142, Beta-herpesviruses, 66
disease, 37–38 223, 225–226 Beyond Balance, 142, 223
delay in treating, 14 Antimicrobial properties, B. henselae, 56
signs of, 35–36 essential oils with, 232 Bifidobacterium species, 71,
Adolescent patients, 41–42 Antinuclear antibodies, 45 127, 129
Adrenal fatigue, 49, 155, 156–157 Anti-yeast diet, 132–133 Binders, 139–140
Adrenal glands, supporting, Anxiety, 12, 46, 49, 72, 74, 106, Bio-Botanical Research, 142,
143–145 120, 180, 185, 193, 198 223
Adrenal salivary index, 90–91 Applied Environmental Biofield therapies, 9, 210
Age-specific challenges, 40–42 Microbiology, 62 Biofilm-busting supplements,
Air purifiers, 137 Arachnids, 15 142–143
Alka-Seltzer Gold, 123 Archetypes, 211 Biofilm defense, 33, 34–35
Allergies, food, 52, 91–92 Arkansas, 58 Bioflavonoids, 227
Alpha-herpesviruses, 66 Arthritic disease, 36 The Biology of Belief (Lipton),
Alpha lipoic acid, 160, 224 Arthritis and Rheumatology, 45 190
ALS (amyotrophic lateral Ashwagandha, 227 Biophotons, 210–211
sclerosis), 44 Asia, 16, 29, 56 Bird feeders, 22
Alternative Therapies in Health Aspergillus species, 71 Black cumin seed oil, 224, 228
and Medicine, 210 Auric field, 210–211 Black-legged tick, 16
American dog tick, 59 Aurum, 216 Black walnut, 226
American Journal of Health, 170 Australia, 29, 52, 60 Blebs, 33
American red squirrel, 32 Autoimmune diseases, 36, 45, Blind spots, 42
American wood tick, 59 46 Blood pressure, 46, 47, 85, 144
Amoebas, 74–75 Autoimmune/inflammation Blood, with bartonellosis, 58
Amyotrophic lateral sclerosis panel, 86 Blue flag iris, 226
(ALS), 44 Autonomic dysfunction, 46, 155 Blurred vision, 42
Anaplasmosis, 26, 29, 55, 58–59, Autonomic imbalance, 46 The Book of Herbal Wisdom:
102–103, 104 Autonomic nervous system Using Plants as Medicine
AncestryDNA, 93 (ANS), 46, 51, 195, 197 (Wood), 140
Andropause, 49 Borage oil/black currant oil,
Angiogenesis, 57 228
Ankylosing spondylitis, 45 Babesia duncani, 9 Borrelia burgdorferi. See
Antianxiety medications, 51, Babesia microti, 12, 26, 29 B. burgdorferi
149 Babesia species, 39, 51, 55, Borrelia lymphocytoma, 50
Antibacterial ointment, 25 72–73, 84, 104 Borrelia mayonii, 32
Antibiotic resistance, 34–35 Babesiosis, 49, 72–74, 102–103 Borrelia miyamotoi, 16, 32
Antibiotic treatment, 12. See Bach Centre, 155 Borrelia species, 20, 26, 43
also Medication(s) Bach, Edward, 155 Borrelia strain, 17
acute infection treated with Bach, Gregory, 38 B. quintana, 56
single dose, 35 Bacopa, 228 Brain, Lyme disease in the,
author’s personal experience Bacteria, biofilm and, 34 146–150
with, 27 Bacterial antibiotic resistance, Brain neuroplasticity, 182–183,
divergent opinions about, 101 34–35 189–190
dosing schedule, 121, 123 Bacterial coinfections, 56–61 The Brain That Changes Itself
most prescribed antibiotics, Bacterial infections, 62–63 (Doidge), 190
100 Bactrim, 59 Bransfield, Robert, 184, 196
not given after the initial Bartonella infection, 49, 81, 196 Breathing, deep, 137–138
three weeks, 12 Bartonella species, 43, 56 Brennan, Barbara Ann, 214
during pregnancy, 39 Bartonellosis, 56–58, 102–103 Brown dog tick, 59
Rocy Mountain spotted fever, B. bacilliformis, 56 Bull’s eye rash, 14, 19, 30, 31, 32,
60 50, 102, 104
treatment duration, 14, 101 Bundle branch blocks, 51
Burdock root, 224 symptom profile of, 42–52 Cyst form of spirochetes, 33
Burgdorfer, Wilhelm “Willy,” 28 treatment of acute infection Cytokines, 145–146
Byron White Formula, 142, 223 and, 14, 35 Cytomegaloviruses (CMV),
Chronic strep infections, 44 66, 67
Climate change, 20
C. albicans, 71, 81, 87, 130, 131 Clostridium difficile, 127
California, 29 Clothing, treated, 22 Dandelion, 139
Canada, 16, 29, 55, 65 Clove, 226 D. andersoni, 59, 60
Candida antibodies, testing for, Coconut oil, 133, 140 Dean Center for Tick Borne
83, 87 Cognition support, 146–150 Illness, 169
Candida (yeast) species, 71, Coinfection panel, 83 Deep breathing, 137–138
131, 132 Coinfections, 54–75 Deer, 20
Cannabis, 158, 159 bacterial, 56–63 Deer ticks, 16, 21, 29, 58
Cardiovascular system, symp- chlamydia pneumonia, 63 DEET, 23
toms related to, 50–51 explained, 54 Delaware, 29
Carpal tunnel syndrome, 50 fungal, 71–72 Depersonalization, 147
Catastrophic thinking, 202 medications and, 101 Depression, 12, 49, 106, 110,
Cats, 24, 56 mycoplasma pneumonia, 193, 198
Cat scratch fever, 56 62–63 Dermacentor andersoni, 59
Cave and Cosmos: Shamanic naturopathic doctor’s Dermacentor variabilis, 59
Encounters with Another approach to, 55–56 Detoxification, 133–140
Reality (Harner), 219 overview, 54–55 DHEA, 144, 227
C. burnetii, 60, 61 parasitic, 72–75 Diagnosis. See also Testing
CD-57 test, 84–85 testing, 54–55 autonomic dysfunction and,
Celiac disease, 69, 83, 85, 89–90 viral, 64–70 46
Cell phones, 137 Cold-pressed coconut oil, 133 of children with tick bites,
Centers for Disease Control Collagen fibers, 165 40–41
and Prevention (CDC), Collective trauma, 186, 189 of fibromyalgia, 45
30, 77, 105, 119, 210 Collective unconscious, 211 misdiagnosis, 12, 36, 43
Central nervous system, 33, 42, Combating Biofilms: Why Your of mononucleosis, 69
147, 175, 195 Antibiotics and Antifun- patients feelings after a,
C. glabrata, 71 gals Fail (Schaller), 143 179–180
Chakra system, 212, 213 Complementary and alternative trust in naturopathic doctor
Chelation therapy, 92, 122 medicine (CAM), 103, 106 and, 55–56
Chicken pox, 66, 70 Complete blood cell (CBC) Diagnostic and Statistical
Chickens, protecting yourself count, 83, 86–87 Manual of Mental
from ticks and, 22 The Complete Book of Essential Disorders (DSM-5), 181
Children. See also Teenagers Oil (Worwood), 163 Diet
dosing schedule for, 121 Comprehensive metabolic anti-yeast, 132–133
educating about ticks, 22 panel, 83, 86–87 bitters, 138–139
mothers transmitting Lyme Constitutional homeopathy, 153 flora-supported, 129–130
disease to, 38–40 Consumer Reports, 22–23 genetically modified foods,
neuroception and, 198 Contemplative practices, avoiding, 135
parents’ denial of Lyme 200–201, 202–204 neuroinflammation and,
disease in their, 112 Conventional medicine, using 148–149
Q fever and, 61 natural medicine with, organic foods, 135, 136
at risk for tick bites, 40 98–100 organic meat, 135
suicide risk, 184–185 Conversion disorder, 46, removing sugar from, 132–133
symptoms of Bartonella in, 57 191–192, 193 Diffuser, essential oils in a, 162
trauma and, 182 CoQ10, 160 Digestive system, symptoms
Chinese Classics, 142 Cord blood testing, 38 related to, 51–52
Chinese medicine, 168, 170–173 Cordyceps, 227 Dilated pupils, 43
Chlamydia pneumonia, 62, 63 Cortisol, 90–91, 144, 195 Dispenza, Joe, 194
Chronic infections Cost issues, 119–120 Dissociation, 181–182
biofilm and, 34 Cottontail rabbits, 61 Doctor(s). See also Health care
Chronic Lyme disease. See also Counseling, 110, 185–186 practitioners; Lyme-
Lyme disease Coxiella burnetti, 60 literate doctor; Primary
acute Lyme disease Crandell, David, 169 care provider (PCP)
becoming, 36–37 Craniosacral work, 165, 175, 177 advocating for yourself with,
blebs and, 33 C-reactive protein, 45 107–109
influencing your daily life, 14 Cryptococcus neoformans, 131 denial of Lyme disease, 192
post-traumatic stress Cupping, 171–172 influencing patient’s
disorder and, 183–184 Curcumin, 34, 148, 150, 224, response to medication,
support from the family, 225, 231 194
109–111
249
moving from one to the next, Estrogen dominance, 48 Galaxy labs, 81
112 Etheric body, 213 Gamma-aminobutyric acid
talking about Lyme disease Europe, 16, 29, 50, 53, 56, 65, 173 (GABA), 147, 228
with, 97–98 Exercise, 165–170 Gamma-herpesviruses, 66
viewed as a teacher, 8 Eyes, symptoms related to the, Garlic, 34, 227
without training in natural 42–43 Garlic spray, 23–24
medicine, 99 Gastroparesis, 52
Dogs, 24 Genetically modified foods, 135
Doidge, Norman, 190 Family Genetic Genie, 93
Dot blot (testing), 79 getting support from, 109–110 Genetic testing, 93–94
Doxycycline, 14, 35, 100, 121 trangenerational trauma, Genital herpes (herpes simples
Dr. Google, 107 187–189 virus II), 65, 66, 67–68
Dry cupping, 172 Family Constellation Work, 187 Genomic sequencing, 29
Dysautonomia, 46 Fatigue, 12, 47, 49 German chamomile, 228
FDA approval, 82 Germany, 53
FDA, structure-function claims Gingerroot, 228
Early disseminated infection, and, 116 GlaxoSmithKline, 82
36 Female ticks, 16 Globe artichoke, 224
Ears, symptoms related to, 43 Fermented foods, 130 Glucomannan, 129
Eastern medicine, 213. See also Fever therapy, 53 Glutamate, 148
Chinese medicine Fiber, 130 Glutathione, 139
Ehrlichiosis, 26, 52, 58–59, 81 Fibromyalgia, 45 Gluten intolerance testing, 83,
Einstein, Albert, 210 Fifth disease, 70 89–90
Electrolytes, 155–157 Fight-or-flight response, 46, Gotu kola, 228
ELISA (enzyme-linked immu- 143, 148, 184, 195 Gou teng, 229
nosorbent assay), 77–78 Filtered water, 135 Government funding, 119
Elk Mountain Herbs, 142 Fish oil, 224, 228 Grapefruit seed extract, 226
Emotional muscle memory, 175 5-HTP/L-tryptophan, 228 The Great Imitator, 36
Emotional release, 202 Flagellum (tail), 31 Green cleaning products, 134
Emotional work/detoxification, Floaters, 42–43 Green Dragon Botanicals, 223
201–204 Flotation REST therapy, Green Hope Farms, 155
Emoto, Masaru, 152 172–173 Green tea extract, 34, 148, 224
Encephalitis, 59, 65–66, 68 Flotation therapy, 172–173 Grof, Stan, 207
Endocrine system, symptoms Flower essences, 155 Guinea hens, 22
related to, 47–49 Food(s). See Diet Gurwitsch, Alexander, 211
Energy anatomy, 9, 212–214 Food sensitivities, 51–52 Gut
Energy-clearing symptoms, 220 Food sensitivity panels, 91–92 fungal coinfections and, 71
Energy healing, 8 Forskolin, 228 inflammation in the, 51
Energy medicine, 206–220 Foundational Naturopathic microbes and, 127, 128
author’s experience with, Treatment Plan, 125–150 natural medications and, 147
207–208 adrenal glands, support for, prebiotics and, 129
biofield therapies, 210–211 143–145 Gut-Brain Axis, 197
collective unconscious, 211 antimicrobial herbs, 140–142
detoxification symptoms, 220 basic elements, 222–223
energy anatomy, 212–214 biofilm busters, 142–143 Hahnemann, Samuel, 151, 152
microbes and, 214–216 cognition support, 146–150 Hair, symptoms related to,
plant-based, 212 detoxification, 133–140 49–50
Reiki, 219 healthy microbiome, 126–133 Hands of Light: A Guide to
shamanism, 217–219 natural anti-inflammatories, Healing Through the
working with a provider in, 145–146 Human Energy Field
208–210 treatment goals, 125–126 (Brennan), 214
Enteric nervous system, 147, Fragmentation, 181–182 Hard-bodied tick, 16
195, 197 Francisella tularensis, 61 Hard-bodied ticks, 32, 60
Environment, ticks and the, Frontiers in Human Hares, 61
19–21 Neuroscience, 200 Harner, Michael, 219
Epigenetics, 93, 190–191 Frontiers in Medicine, 161 Hatha yoga, 167
Epsom salt bath, 123, 162 Frontiers of Microbiology, 147 Headaches, 42
Epstein-Barr infections, 44 Fructo-oligosaccharides (FOS), Head, symptoms related to, 42
Epstein-Barr virus, 65, 66, 129 Health care practitioners. See
68–69, 84 Fungal coinfections, 71–72 also Doctor(s); Primary
Erythema chronicum migrans. care provider (PCP)
See Bull’s eye rash complementary and
Essential oils, 23, 133, 161–163, Gaia Herbs, 142, 223 alternative medicine
232 Gaia hypothesis, 214 (CAM), 103, 106
energy medicine providers, Human parvovirus B19, 70–72 Inflammatory bowel disorders,
208–210 Hyaluronic acid, 50 50
using both conventional Hydrotherapy, 53 Infrared saunas, 176
and natural medicine, Hyperacusis, 43 Injuries, symptoms emerging
98–99 Hypericum species, 227 after a, 48
Heavy metal testing, 92 Hypnotherapy, 43 Insect Shield, 22
Hellinger, Bert, 187 Hypothyroidism, 47, 85 Insurance companies/coverage
Helminths, 74–75 Hypoxia, 50, 174 IDSA standards and, 105
Herb Pharm, 142, 223 reinfection not supported
Herbs/herbal support by, 32
adrenal-supportive, 227 IgE immunoglobulin, 91–92 testing and, 78, 81, 83
anti-biofilm sensing IGeneX labs, 17, 77, 78, 81 Internal use of essential oils,
properties, 34 IgM bands, 78 162
antibiotic treatment used Immobilization (polyvagal International Journal of
with, 101 theory), 199, 200 Infectious Disease, 102
antimicrobial herbs, 140–142, Immune system International Lyme and
223, 225–226 flora-supported diet and, 130 Associated Disease
biofilm-inhibiting, 227 immunity to Lyme disease, Society (ILADS), 14, 28,
for detoxification support, 31–32 99, 105–106
224–225 Lyme disease vaccine and, 82 Internet research, 106
energy medicine, 212 spirochetes and, 30, 31, 33 Interoception, 200–201
knowing origin of, 116 of ticks, 18 Intravenous immunoglobulin
pain management with weakened, with Lyme therapy (IVIg), 89
medicinal, 158 disease, 44 Intravenous (IV) therapy,
reducing neuroinflammation, Immunoglobulin levels, 83, 89 157–158
148 Indirect testing, 78 Inulin, 129
Herpes simplex virus I, 66, Individual trauma, 186, 187 It Didn’t Start with You: How
67–68 Infected ticks Inherited Family Trauma
Herpes simplex virus II, 66, increase in, 15, 29 Shapes Who We Are and
67–68 taking care of an embedded How to End the Cycle
Herpes viruses, 66–70 tick and, 24–25 (Wolynn), 188
Herpes zoster, 70 topical sprays repelling, Ixodes pacificus, 16
Herxheimer reaction, 51, 110, 22–23 Ixodes persulcatus, 16
122–123, 141, 165, 174–175, vertical transmission, 16–17 Ixodes ricinus, 16
184 Infection(s). See also Ixodes scapularis (deer ticks),
The Hidden Messages in Water Coinfections 16, 29, 58, 65
(Emoto), 152 bacterial, 62–63 Ixodes species, 52, 62, 73, 106
HLA-B27 marker, 43, 47, 82, 86 failure to treat, 102–103
HLA-DR genetic panel, 83, getting tested for. See Testing
88, 94 reinfection, 31–32 Japanese knotweed, 226
Holobiont, 214 tick attachment time and, 19 Jarisch-Herxheimer reaction.
Hologenome, 214 transmission of. See See Herxheimer reaction
Holy basil aka tulsi, 227 Transmission Joint capsules, 33, 36, 45, 86
Homeopathic drainage, 153 variables increasing chance Joint swelling, 45, 70
Homeopathic medicine, 26 of, 19 Jones, Charles Ray, 39
conventional homeopathy, Vitamin D and, 156 Journal of Clinical
153 white-footed mouse as Microbiology, 32
flower essences and, 155 source of, 19–20 Journal of Inflammation, 44
miasms, 152–153 Infection and Immunity, 32 Jung, Carl, 211
nosode therapy, 153 Infectious disease doctor, 12 Juvenile rheumatoid arthritis,
placebo effect and, 192 Infectious Diseases Society of 45
premise of, 151–152 America (IDSA), 101–102,
Hormone imbalance, 48, 85, 104–105
144–145 Inflammation Kava kava, 229
Horseradish root, 227 blebs and, 33 Kefir, 130
Hot fomentation, 53 essential oils and, 161 Kilodaltons (kDa), 78
Houttuynia, 226 natural anti-inflammatories, Kimchi, 130
Hoxsey-like formula, 224 145–146 Kirlian photography, 213
Human herpesvirus 6 (HHV-6), neuroinflammation, 146–150 Klinghardt, Dietrich, 215
66, 68 physical medicine and, Kombucha, 130
Human leukocyte antigen B27 165–166 Kundalini yoga, 167
(HLA-B27), 86 Inflammation/autoimmune Kynurenine pathway, 148
Human Microbiome Project, panel, 83, 86
126–127
INDEX 251
LabCorp, 78, 87 Male/female hormone panels, Microbiome, maintaining a
Lab results, 56, 79–80, 81, 90 83, 85 healthy, 126–133
Lactobacillus, 71, 127 Male ticks, 16 Microflora, maintaining
Late disseminated infection, 36 Malic acid, 229 healthy, 127
Lavender, 229 Mapalo, 230 Microglia, 147
Lawn, sprays for treating, 23 Margulis, Lynn, 214 Middle East, 56, 60
Law of Attraction/Law of Maryland, 29, 58 Migraines, 42
Mirroring, 215 Massachusetts, 58 Milk thistle, 225
Law of Similars, 151–152 Massage therapy, 161, 165, 168, Mindfulness practices, 138, 145,
L-carnitine, 160 173–175 158, 200, 201, 206
Leaf litter, 21–22 Mast cell activation syndrome Minnesota, 29, 32
Lemon Eucalyptus Insect (MCAS), 146 Minocycline, 100, 121
Repellent Spray, 23 Mast year, 20 Miso, 130
L-form of spirochetes, 33 Mayo Clinic, 32 Mississippi, 58
Licorice root, 224, 227 Meat, organic, 135 Misty Meadows, 142
Light fields, 210–211 Medication(s). See also Mitochondrial support, 159–160
Lightheadedness, 42, 155 Antibiotic treatment Mixed connective tissue
Light sensitivity, 42, 43, 154 antianxiety, 51, 149 disease, 36, 45
Lilly, John, 172–173 for bartonellosis, 58 Mobilization (polyvagal
Lion’s mane, 229 costs, 120 theory), 199, 200
Liposomal glutathione, 123 for ehrlichiosis/anaplasmo- Mold toxins, 88
Lipton, Bruce, 190 sis, 59 Mononucleosis, 44, 69
Liver detoxification, 138–139 finding the ideal regimen Montana, 60
Lone Star tick, 58 with, 100–103 Moose, 20–21
Lou Gehrig’s disease, 44 for Francisella tularensis, 61 Mora, Esther, 211
Lovelock, James, 214 for fungal coinfections, 72 Mora Technique 7 Layers of
Love Thyself (Emoto), 152 for infection with helminths the Heart, 211
Low blood pressure, 46 or amoebas, 75 Morphic resonance fields, 211
Low-dose immunotherapy maintaining a schedule for, Morphogenetic fields, 211
(LDI), 153–154 120–121, 123–124 Mosquito Barrier, 23–24
Lumosity, 190 mood-enhancing, 57 Mother-to-child transmission,
Lupus, 36, 69, 86 for mycoplasma pneumonia, 38–40
Lyme, Connecticut, 28 63 Mouse, 19–20
LymeCore Botanicals, 142 nocebo effect, 193–194 Movement, 167–168, 203–204
Lyme Core Protocol, 223 placebo effect, 192 Moxibustion, 172
Lyme disease, 13–14. See also for Q fever, 61 Mullein, 226
Acute Lyme disease; for Rocky Mountain spotted Multiple sclerosis, 36, 44, 67,
Chronic Lyme disease; fever, 60 139
Coinfections; Infection(s) viral coinfections, 65 Musculoskeletal system, symp-
age-specific challenges of, Medicine and Science in Sports toms related to, 45, 47
40–42 and Exercise, 168 Mycoplasma pneumonia, 62
author’s experience with, 9 Meditation, 46, 123, 138, 148, Myofascial pain syndrome, 174
becoming immune to, 31–32 201, 203 Myss, Caroline, 207, 214
denial of, 112–114 Medium-chain triglycerides, Myss’s Anatomy of the Spirit:
as the disease of the soul, 226 The Seven Stages of
214–215, 216 Mega-dose probiotics, 128–129, Power and Healing
naming of, 28 130 (Myss), 214
reemergence of, 29 Mein, Carolyn L., 163
stages of severity, 36 Melanocyte-stimulating
transferred through sexual hormone, 88 NADH/NAD, 160
intercourse/saliva, Melatonin, 230 Nails, symptoms related to,
37–38 Membrane phospholipids, 160 49–50
Lyme-literate doctor, 108 Meningitis, 59 Nasal swab culture, 44, 94
author as, 7, 9 Menstruation, 47–48 National Health Interview
downplaying patient’s Mental-emotional detoxifica- Survey, 210
symptoms, 40 tion, 201–202, 201–204 National Institutes of Health,
medical trauma of patients Meridians, 171, 212, 213 126
and, 180–181 Metabolic panel, 86–87 National University of Natural
role of, 103, 106 Metagenics, 128 Medicine, 7
self-advocacy and, 108, 109 Mexico, 59 Natural anti-inflammatories,
skill set of, 98 Miasms, 152–153 145–146, 149–150, 228–231
Lymerix, 82 Michigan, 29 Natural Areas Journal, 20
Microbial diversity in ticks, 64 Natural killer cells, 66, 84
Microbiogenetics, 214–216
Natural medicine/treatments, antibiotic treatment used Pediatric autoimmune neuro-
8. See also Herbs/herbal with nutrient support, psychiatric disorders
support; Homeopathic 101 associated with
medicine antifungal, 224 streptococcal infections
for bartonellosis, 58 biofilm-inhibiting, 227 (PANDAS), 184–185
of chlamydia pneumonia, 63 for detoxification support, Pediatric Lyme disease, 39
for ehrlichiosis/anaplasmo- 224–225 Pennsylvania, 29, 65
sis, 59 feeding your mitochondria, Pericarditis, 51
forcing spirochetes into 160 Peripheral nervous system, 44,
circulation, 80 flora-supportive diet, 129–130 46, 195
for Francisella tularensis, 61 Nyctanthes arbor, 226 Permethrin, 22, 23
for fungal coinfections, 72 Pest management, 23–24
for infection with helminths Pets, 23, 24
or amoebas, 75 Oil of oregano, 34 Phelps, Michael, 172
for mycoplasma pneumonia, Oil pulling, 140 Phosphatidylserine, 230
63 Oklahoma, 58 Physical medicine, 164–177
paired with antibiotic Opioid crisis, 158 Chinese medicine, 170–173
treatment, 26 Oral herpes (herpes simplex craniosacral work, 175, 177
for Q fever, 61 virus I), 66, 67–68 exercise, 165–170
for Rocky Mountain spotted Orbs, 42 massage therapy/musculo-
fever, 60 Oregano oil, 161 skeletal manipulation,
using conventional medicine Oregon, 16, 29 173–175
with, 98–100 Organic foods, 135, 136 overview, 164–166
Nature Ecology and Evolution, Organic lawn sprays, 23 sauna therapy, 176
29 Organic meat, 135 Picardin, 23
Nature Genetics, 69 Organon of Medicine Pink noise therapy, 43
Naturopathic doctors (Hahnemann), 151–152 Placebo effect, 192
doctors’ understanding of, Orthostatic hypotension, 46 Plant-based foods, 130
108 Outer surface proteins (OSP), Plant-based medicine, 140–142,
patients’ trust in, 55–56 31 212
training, 165 Oxford Journal, 132 Plaque, 34
Naturopathic medicine, 7 Plastic, microwaving in,
author’s experience and 134–135
beliefs on, 7–8 Polymerase chain reaction
Pain body, the, 201–202
shamanism and, 219 (PCR), 79
Pain relief, 158
tenets of, 8 Polypharmacy, 116
Panax ginseng, 227, 230
Nervous system, 195, 197 Polyvagal theory, 197–198
Pancreatic enzymes, 230
MORE Popp, Fritz-Albert, 211
Parasitic coinfections, 72–75
Nettles, 226 Porges, Stephen, 198
Parasympathetic nervous sys-
Neural biofeedback, 43 Positive titers, 39
tem, 46, 177, 195, 197, 199
Neuroception, 198–200 Post-Lyme syndrome, 12, 14, 105
Parkinson’s disease, 36, 44, 139
Neuroinflammation, 7, 146–150, Post-traumatic stress disorder
Patients
183, 184 (PTSD), 183–184
adolescent, 41–42
Neurological disease, 36 Post-treatment Lyme disease
aggressive/violent tendencies
Neurological systems, 44–45 syndrome (PTLDS),
in, 196
Neuroplasticity, brain, 182–183, 101–102
author’s three new, 11–13
189–190 Postural orthostatic tachycar-
compassion for, 7
Neurotransmitter panels, 91 dia, 46
costs of Lyme disease for,
New England area, 29 Powassan virus, 65–66
119–120
New Hampshire, 58 Prana, 213
denial of having Lyme’s
New Hampshire Fish and Prebiotics, 87, 101, 129
disease, 112–114
Game, 20–21 Preformation, 190
denied testing and treatment,
New Jersey, 29 Pregnancy
11–13
New York, 29, 65 Q fever and, 61
family support for, 109–110
Nix, 22 transmission of Lyme disease
feelings of, after a diagnosis,
N-methyl-D-aspartate during, 38–40
179–180
(NMDA), 148 Western blot testing, 78
finding a balanced approach
Nocebo effect, 193–194 Prevention
to care, 98–100
Nonstick cookware, 134 naturopathic medicine
medication schedule for,
Nosode therapy, 26, 153 supporting, 8
120–121, 123–124
Nutraceuticals, 212 tick-bite, 21–24
misdiagnosed, 12
Nutramedix, 142, 223
new cases of, 11
Nutrients
reinfection, 31–32
adrenal-supportive, 227
trauma and, 180–189
INDEX 253
Primary care provider (PCP). Rheumatoid arthritis, 36, 45, Shoemaker, Ritchie, 88
See also Doctor(s); 62, 69, 70, 86 Short-chain fatty acids, 130
Health care practitioners Rheumatoid factor, 45 Shortness of breath, 51
advocating yourself with, Rhipicephalus sanguineus, 59 Sho-saiko-to, 225
107–109 Rickettsia rickettsii, 59 Sinovial fluid, 45
diagnosis by, 12 Rickettsia species, 43 Sinus headaches, 44
influence of attitude from, Rife machines, 208 Sjögren’s syndrome, 36, 45, 86
194 Ringing in the ears, 43, 175 Skin biopsy culture, 32
referrals to specialists from, Rios, Miguel Ojeda, 214 Skin brushing, 137
98 R. massiliae, 59 Skin, symptoms related to,
refusing testing for Lyme R. montanensis, 59 49–50
disease, 12 Rocky Mountain spotted fever, Skullcap, 226
working with a Lyme-literate 51, 52, 59–60, 102–103 Small intestinal bacterial over-
doctor, 103, 106 Rodents, 19–20 growth (SIBO) hydrogen
Probiotics, 27, 87, 101, 127, Rolfing, 175 breath test, 94–95
128–129, 130, 222 Rosemary, 230 Smoking, 135
Protozoa, 72 Rosenberg, Eugene, 214 Socialization (polyvagal
Psychosomatic illness/medi- Roseola (Human theory), 199, 200
cine, 46, 191–192, 193 herpesvirus 6), 68 Social support, 109–111, 187
Psychospiritual crisis, 207 Rosetta Stone, the, 88 Soft-bodied ticks, 32
Pyrethrum, 23, 24 Routine testing, 81–83, 84–90 Sore throats, 44
Pyrroloquinoline quinone R. parkeri, 59 Sound-cancelling headphones,
(PQQ), 230 R. phillip, 59 43
Russia, 65 Sounds, hypersensitivity to, 43
Southern states (U.S.), 29
Q fever, 60–61 Spaulding Rehabilitation
Qi (Chi), 171, 213 Saccharomyces boulardii, 87, Hospital, 169
Qigong, 168–170, 200, 203–204 130, 132 Specialized lab tests, 81
Quantum entanglement, 210 Sacred space, creating a, 203 Specialty testing, 83, 90–95
Quest Diagnostics, 78, 87 Saffron, 230 SpectraCell, 87
Quorum sensing, 34 Saliva, Lyme disease Spider veins, 57
transmitted through, 37 Spiral form of spirochetes, 33
Saliva, tick, 18 Spiritual emergency, 207
SA Me (S-adenosyl-L- Spirochetes, 7
Rabbit fever, 61–62
methionine), 231 areas of the body liked by, 36
Rage issues, 196
Sapi, Eva, 34 bull’s-eye rash and, 30
R. amblyommii, 59
Sarcoidosis, 45 Burgdorfer, Wilhelm and, 28
Rashes, 30. See also Bull’s eye
Sarsaparillo, 231 movement of, 30–31
rash
Sauerkraut, 130 relationship with the host
with acute infection, 35
Saunas/sauna therapy, 123, (tick), 29
with babesiosis, 49
137, 176 releasing in the bloodstream
with bartonellosis, 57–58
Scar tissue, spirochetes in, for testing, 80
with Borrelia mayonii strain,
36, 48 survival in saliva, 37
32
Schaller, James, 143 tick attachment time and,
variables involved in
Schools, working with, 111–112 18–19
developing, 30
Sea-Band, 42 transformative ability of, 33
Raynaud’s syndrome, 58
Second brain, 147, 197 Steere, Allen, 28
Red/bluish lesions, 50
Sedimentation rate, 45 Stephania root, 226
Red meat allergy, 52
Self-advocacy, 7 Steroids, 47
Red root, 226
talking to your health care Stevia, 80, 227
Reiki, 161, 200, 210, 219
provider and, 97–98 St. George Clinic, Germany, 53
Reinfection, 31–32
with your doctor, 107–109 Stigma, 185
Relapsing fever infection, 32
at your workplace and St. John’s wort, 231
Releasing Emotional Patterns
school, 111–112 Stool analysis, 93
with Essential Oils (Mein),
Sensory deprivation therapy, StrateGene, 93
163
172–173 Strep infections, 44
Renew Life, 128–129
Seresto collar, 24 Streptococcus, 127
Repression, 181–182, 195
Serotonin, 147, 148–149 Stretch marks, 49
Research Nutritionals, 223
Serrapeptase, 80, 223, 231 Stricker, Raphael, 84
Research, on conventional
Shamans/shamanism, 9, 212, Sugar, 132
treatment time, 101–102
217–219 Suicide risk, 184–185
Resistance training, 168
Shame, 110, 182, 185, 191–192 Sulfa medications, 60
Respiratory system, symptoms
Sheldrake, Rupert, 211 Sun, Guan-Cheng, 169
related to, 50–51
Resveratrol, 230 Shingles, 70
Supplements, 115–116. See also sensation of bugs creeping on stool analysis, 93
Prebiotics; Probiotics the skin, 37 thyroid hormone panel,
biofilm-busting, 142–143 in teenagers, 41 85–86
for cognitive support, toxic mold exposure, 88 vitamin and mineral status
149–150 during treatment, 118 report, 87
dosing schedule, 123 of varicella zoster, 70 Testing the tick, 25–26, 40, 55
Vitamin D, 156 Systemic yeast overgrowth, Tetracycline medications, 60,
Support groups, 111 130–131 100
Surviving Mold (Shoemaker), Thom, Dickson, 164
88 Throat, symptoms related to
Swedish Bitters, 139 Tai Chi, 168–170, 203–204 the, 44
Swedish bitters, 225 Tail (spirochetes), 31 Thyroid hormone panel, 83,
Sympathetic nervous system, Teasel, 226 85–86
46, 195, 199 Teenagers, 41–42 Tick attachment time, 18–19, 59
Symptoms, 11 Tempeh, 130 Tick bite(s). See also
acute Lyme disease infection, Tennessee, 58 Treatment(s)
35–36 Testing, 76–95 location of, 17
of author during pregnancy, adrenal salivary index, 90–91 most common age groups at
39–40 balanced approach to, 79–81 risk for, 40
in author’s new patients, for Candida antibodies, 87 prevention, 21–24
11, 12 CD-57 test, 84 rashes around, 30
of Bartonella, 56–57 for children, 40 reaction on the skin, 30
with Borrelia miyamotoi, 32 coinfection, 54–55 reinfection with, 31–32
cardiovascular and respirato- common lab tests, 83 removal of the tick, 24–25
ry system, 50–51 complete blood cell (CBC) seasons for, 21
in children, 40–41 count and metabolic taking action right after a, 15
of chlamydia pneumonia, 63 panel, 86–87 Tick-borne Diseases Passive
cytomegalovirus (CMV), 66 doctors refusing, 12, 13 Surveillance database, 29
digestive system, 51–52 ELISA and Western blot, Tick-borne encephalitis, 65–66
of ehrlichiosis/anaplasmosis, 77–79 Tick-borne infections. See also
58–59 food sensitivity panels, 91–92 Infection(s); Treatment(s)
emerging after a trauma to genetic, 93–94 Herxheimer reaction,
the body, 48 gluten intolerance, 89–90 122–123
endocrine system, 47–49 heavy metal, 92 insurance coverage and, 81
energy-clearing, 220 HLA-DR genetic panel, 88 tick testing, 40
Epstein-Barr virus, 69 IDSA standards, 104 Tick checks, 22, 23
fever, 53 immunoglobulin levels, 89 TickReport, 25, 29
of Francisella tularensis, 61 inflammation/autoimmune Ticks. See also Infected ticks
fungal coinfections, 71–72 panel, 86 the environment and, 19–21
herpes simplex virus, 68 less common tests, 79 life cycle and tendencies of,
human herpes virus 6 limited to looking for only 15–18
(HHV-6), 68 one strain, 28 location of infected, 16, 29
of human parvovirus B19, 70 microbes, 128 microbial diversity in, 64
late dissemination infection, mother-to-child transmis- need to maintain moisture,
36 sion during pregnancy, 17–18
musculoskeletal system, 38–39 protecting yourself from,
45, 47 nasal culture, 94 21–24
of mycoplasma pneumonia, negative lab results, 76–77 size of, 17
62–63 neurotransmitter panels, 91 Tick testing. See Testing the
nervous system, 44–45 positive results, 26 (See also tick
persistent, after treatment, Treatment(s)) Tick tubes, 23
101–102 rash presentation and, 102 Tinctures, 141
of Powassan virus, 66 recommendations on Tinea versicolor, 50
of Q fever, 61 frequency of, 15 Tinnitus, 43
receiving treatment routine tests, 83, 84–90 Titers, 77–78
regardless of, 19 routine versus specialized, Tolle, Ekhart, 201–202
related to skin, hair, and 81–82 Topical application of essential
nails, 49–50 self-advocacy with your oils, 162
related to the head, eyes, doctor and, 108 Topical sprays, 22–23
ears, nose, and throat, small intestinal bacterial Touch, therapeutic, 210
42–44 overgrowth (SIBO) Toxins
of Rocky Mountain spotted hydrogen breath test, detoxification, 133–140
fever, 60 94–95 mitochondria and, 160
specialty, 83, 90–95
INDEX 255
Traditional Chinese Medicine, received regardless of Water, filtered, 135
168, 170–173 symptoms, 19 The Way of the Shaman
Transgenerational trauma, 185, recommendations on length (Harner), 219
186, 187–189 of, 26 Weather patterns, changing,
Transmigration, 30 research on persistent 20–21
Transmission symptoms after, 101–102 Weight-bearing exercise, 168
of ehrlichiosis and restrictive guidelines limiting Western blot test, 31, 38, 77–78,
anaplasmosis, 58 access to, 104–106 80, 82
Francisella tularensis, 61 risks associated with denial White blood cells, 58, 67, 86
of human parvovirus B19, 70 of, 6 White-footed mouse, 19–20, 32
mother-to-child, 38–40 supplements, 115–116 Whole30 program, 132
Powassan virus, 65 toxic mold exposure, 88 Whole person, treating the, 8
of Q fever, 60 until the infection is Wisconsin, 29, 32
Rocky Mountain spotted resolved, 14–15 Wise Woman Herbals, 142, 223
fever, 59 using both natural and Wolynn, Mark, 188
through saliva, 37 conventional medicine, Wood, Matthew, 140
through sexual intercourse, 98–100 Workplace, representing
37–38 Trees, 20 yourself at your, 111
Trauma, 180–189, 197 Turmeric, 34, 148, 224, 225, 231 Worwood, Valerie, 164
Treatment(s). See also Energy Tweezers, 24–25
medicine; Foundational 23andMe, 93
Naturopathic Treatment Xcode Life, 93
Plan; Medication(s); Nat- Xymogen, 223
ural medicine/treatments; Ubiome test, 128
Physical medicine Ultimate Flora, 128–129
for acute bites, 35 UltraFlora, 128 Yard, protecting yourself from
for autoimmune diseases, 47 University of Massachusetts, ticks in your, 21–22
average treatment time, 117 25, 55 Yarrow, 225, 231
avoided by adolescent Urine testing, 79 Yeast balance, supporting
patients, 41–42 Uveitis, 43 beneficial, 130–132
of Bartonella, 57
Yeast infections, 71, 72, 127,
with complementary and
130–132
alternative medicine
Vaccination Yin yoga, 167
(CAM), 103, 106
Lyme disease, 82 Yi Ren Qigong, 169
conventional medicine’s
Powassan virus, 66 Yoga, 46, 123, 138, 167, 200,
approach to, 14
Vagus nerve, 147–148, 199 203–204
coping with ups and downs
Van Leeuwenhoek, Antonie, 34 Yoga nidra, 167
during, 117–119
Varicella zoster, 66, 70 Yogurt, 130
criterion for stopping, 122
Vascular endothelial growth
denial of, 12, 13
factor (VEGF), 57
denial of having Lyme
Vector-borne illnesses, 28 Zhi Zi, 231
disease and, 112, 113–114
Vegetables, organic, 136 Zilber-Rosenberg, Ilana, 214
electrolytes, 155–156
Vertical transmission, 16–17, 39 Zithromax, 52
essential oils, 161–163
Vibrant Wellness, 128 Zubcevik, Nevena, 169
fever therapy, 53
Vincent, Ty, 153, 154
flower essences, 155
Viral coinfections, 64–70
for gastroparesis, 52
Viral meningitis, 59
Herxheimer reaction and,
Viral titer panel, 83
122–123
Virions, 65
homeopathic, 151–153
Vision, symptoms related to,
of hormone imbalance, 85
42–43, 57
IDSA standards, 104–105
Visual Contrast Sensitivity
ILADS standards, 105–106
APTitude Test, 88
intravenous (IV) therapy,
Vitamin and mineral status
157–158
report, 83, 87
low-does immunotherapy,
Vitamin B6, 227
153–154
Vitamin C, 157
mitochondrial support,
Vitamin D, 87, 132, 156
159–160
VSL Double Strength (DS), 128
pain escalating with initial,
45
during pregnancy, 39
psychospiritual aspects of, 7 Waddington, Conrad, 190
Waon therapy, 176

Rising Above Lyme Disease

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RISING

JULIA GREENSPAN, N.D.

© 2019 Quarto Publishing Group USA Inc.

Digital edition published in 2019

Library of Congress Cataloging-in-Publication Data available.

Cover and Page Design: Kelley Galbreath

The information in this book is for educational purposes only. It is not

Persists: References 233

It’s Time to Acknowledgments 246

CHAPTER 10 Index 248

C chronic disease juggernaut that is moving through both the human

• First, do no harm. This principle is about using the least invasive

y naturopathic medical practice is located in southern New Hamp-

The Life and Times of a Tick

Tick Attachment Time

Ticks and the Environment

Ticks Have No Downtime

Protecting Yourself from Ticks

Stay Calm and Tweeze On

In my ofﬁce, antibiotics paired with probiotics are the standard of care.

Can You Become

Game Changers: New Strains

Signs of Acute Infection

When Acute Lyme Disease

Can I Transmit Lyme Disease

irregularities in their periods. Women with chronic Lyme disease almost

SKIN, HAIR, AND NAILS

coinfection is the simultaneous infection of a host by more than

A one pathogen. It has become common to talk about the diverse

Herpes Simplex Virus I and II

Human Herpes Virus 6 (HHV-6)

INFECTION WITH HELMINTHS OR AMOEBAS

Conﬁrming Lyme Disease:

Less Common Tests

• Melanocyte-stimulating hormone, C4a, C3a, TGF`-1, VEGF,

For further information on mold toxins, testing, and treatment, I recom-

The Best of Both Worlds:

Finding the Ideal

Advocating for Yourself

Chronic Tick-Borne Disease

T surrounding a diagnosis of Lyme disease, the complicated politics, and

Choosing the Right Supplements

Chronic Lyme Disease

The Cost of Lyme Disease

• Take your antibiotics at breakfast and dinnertime. Some antibiotics

pharmacy. If you still have questions, contact your doctor or

he Foundational Naturopathic Treatment Plan is about sustainability

T during a difﬁcult recovery process: A treatment is not worthwhile if a

• Reduce inﬂammation and pain.

Whichever direction you choose—either blending natural medication with

T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 127

T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 129

SUPPORTING BENEFICIAL YEAST BAL ANCE

T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 131

T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 133

• Use green cleaning products. Eliminate, where possible, common

Install a water ﬁltration system if one is not already connected to your

• Eat ethically raised, organic meat. Be mindful of where your

T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 135

CLEAN FIFTEEN DIRTY DOZEN

TAKE A DEEP BREATH AND CARRY ON

T H E F O U N DAT I O N A L N AT U R O PAT H I C T R E AT M E N T P L A N 137